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Vitamin B 12 deficiency-induced neuropathy secondary to prolonged recreational use of nitrous oxide

机译:维生素B 12缺乏诱导的神经病变,继发于长期娱乐二氮氧化物

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摘要

A 24-year-old female, otherwise healthy, presented to the Emergency Department (ED) with difficulty walking and bilateral leg pain. The patient was a recreational nitrous oxide (NO2) user, also known as “whippets” or simply nitrous. Neurologic examination demonstrated an unsteady gait and positive Romberg sign along with normal deep tendon reflexes and normal muscle strength in upper and lower extremities. Laboratory results demonstrated macrocytic erythropoiesis, reduced B12, elevated homocysteine, and elevated methylmalonic acid. Outpatient MRI later demonstrated degeneration of the posterior spinal column. The patient was empirically treated in the ED with intramuscular B12and admitted to the evaluation unit for pain control and Physical Therapy (PT) evaluation.Emergency Medicine (EM) physicians should be aware of this condition because NO2is used both recreationally and in medicine. With the popularity of recreational nitrous oxide, many emergency patients have experience with this drug. As in our case report, the toxic effects can be profound and mimic other emergent conditions like stroke. Emergency physicians should have a higher index of suspicion for the toxic effects of this common drug. Elderly, vegetarians and patients with Irritable Bowel Disease are at higher risk and may even experience toxicity from nitrous oxide used therapeutically during routine anesthesia.
机译:一个24岁的女性,否则健康,呈现给急诊部(ED),难以走路和双边腿部疼痛。患者是娱乐中的一氧化二氮(NO2)使用者,也称为“Whippets”或简单的亚硝酸盐。神经系统检查证明了一个不稳定的步态和阳性romberg标志以及上肢和下肢正常的肌腱反射和正常肌肉强度。实验室结果证明了大核红细胞产物,降低的B12,升高的同型半胱氨酸和升高的甲基丙酸。门诊MRI后来证明了后脊柱的退化。患者在患有肌肉内B12和肌内B12的脑内治疗,进入疼痛控制和物理治疗评估单位(PT)评估。药物(EM)医师应该意识到这种情况,因为NO2IS在娱乐和医学中使用。随着休闲含氮的普及,许多急诊患者都有这种药物的经验。与我们的案例报告一样,毒性效应可能是深刻的,类似于行程的其他紧急条件。急诊医生应具有更高的怀疑症状对这种常见药物的毒性作用。老年人,素食主义者和肠道疾病的患者风险较高,甚至可能在常规麻醉期间从治疗过程中使用的氧化亚氧化物的毒性体验。

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