Laughing Gas use

[Galixie]

I was listening to NPR this morning and heard this story:

npr.org/2016/04/01/47264000...

It's about how some hospital ERs are trying to cut down on opioid use by finding alternative pain management solutions. I was mildly dismayed to hear that one hospital in New Jersey has opted to use laughing gas as a first option instead. If that becomes a widespread practice, we may all need to start wearing medical alert jewelry stating 'no nitrous oxide' on it. Laughing gas inactivates B12 and could quickly bring on all of our usual deficiency symptoms.

thelancet.com/journals/lanc...

Most of the literature on this subject relates to long term abuse of nitrous oxide, rather than one-time administration, but, as is mentioned in the lancet article I've linked to above, there are cases where one dose does cause problems.

[fbirder]

I am certain that my, seemingly sudden, onset of B12 deficiency was due to the nitrous I had when having a colonoscopy. I'd obviously been slowly getting worse over a couple of years. No longer could I walk 8 miles in a day. But I'd put it down to getting older.

After my colonoscopy I had problems walking 80 meters. Loads of B12 later and I'm almost back to like I was before. But I'll be refusing N2O from now on.

[Gambit62 Administrator]

pretty sure that nitrous oxide was part of my problems when I was diagnosed as well.

It will be less of an issue if someone is able to absorb and replace B12 but even one dose is going to be really bad news if you aren't able to replace B12 yourself.

[Jose651]

There is a chapter in "Could it be B12" on that very subject. It is worth reading

Unfortunately I hadn't read it before I had a lot of dental work done last year when the anesthetist used it and several injections in my arm of God knows what.  It took me a very long time to get over it. 

Hindsight is a wonderful thing.

J

PS....I photocopied that chapter and sent it to him.

[Galixie]

I mainly had wanted to post about it to remind all of us who have trouble with B12 absorption that it's an issue. If we can't find an alternative and need to have nitrous, we should be requesting a follow up injection of B12 to replenish what the nitrous inactivates.

It would certainly seem like a dilemma to have to choose between taking a potentially addictive opiate or taking a gas that could have immediate detrimental effects. Especially if you're not certain the healthcare provider is going to take your need for additional B12 seriously and actually provide it.

[Sleepybunny]

Hi,

A couple of links about nitrous oxide....

gov.uk/drug-safety-update/n...

martynhooper.com/2015/08/22...

[Sleepybunny]

I suspect that nitrous oxide from "gas and air" during prolonged labour was part of the reason I developed B12 problems,

Why on earth was I not warned by midwives prior to giving birth that use of nitrous oxide could result in neuro difficulties?

No-one involved in ante or post natal care ever mentioned it. Personally I wonder if all those who use "gas and air" for more than a couple of hours should be given a B12 injection after giving birth.

[Jazzw in reply to Sleepybunny]

I think you're right, Sleepybunny. I remember the midwife being slightly shocked about how much gas and air I'd consumed during labour (she'd left me alone for hours) so it must've been a lot. No mention ever made that my B12 would've been affected - but it must've been. No wonder I felt so lousy for months after the birth - I seemed to struggle far more than the other new mums I knew.

[evilellie in reply to Sleepybunny]

Yes, me too. I developed symptoms about a year after my (fairly disastrous) lengthy induced labour, where although I did not want nitrous oxide (as it just made me feel dizzy and sick) it was pushed on me repeatedly and I kind of gave in and used it (really really wish I had known then what I know now!). Now stuck with pernicious anemia forever. I had low iron levels going into labour (no idea about B12), but I think low iron is common in late pregnancy, and is a counter indicator to nitrous oxide use, but apparently they just ignore this! 

In fact, here are the NICE guidelines: evidence.nhs.uk/formulary/b...

Specifically: "Exposure of patients to nitrous oxide for prolonged periods, either by continuous or by intermittent administration, may result in megaloblastic anaemia owing to interference with the action of vitamin B12; neurological toxic effects can occur without preceding overt haematological changes. For the same reason, exposure of theatre staff to nitrous oxide should be minimised. Depression of white cell formation may also occur.

Assessment of plasma-vitamin B12 concentration should be considered in those at risk of deficiency, including the elderly, those who have a poor, vegetarian, or vegan diet, and those with a history of anaemia. Nitrous oxide should not be given continuously for longer than 24 hours or more frequently than every 4 days without close supervision and haematological monitoring."

[Sleepybunny]

This link says there are no harmful side effects to using "gas and air" in labour. 

nhs.uk/conditions/pregnancy...

I wonder if women with low levels of B12 might be at risk and if  women with B12 levels that are just within the normal range who have prolonged exposure might be at risk. If I had known more about nitrous oxide and B12, I would have asked what my B12 levels were before I started to use "gas and air".

Do women in early stages of labour have a B12 test? I'm sure I had blood tests taken in hospital but I didn't enquire what they were for.

[Lindylanka in reply to Sleepybunny]

Isn't the point that it would be some time AFTER pregnancy that a deficiency would occur, months maybe or years ven? I never really recovered from my last pregnancy, was always tired and my baby didn't seem to enjoy feeding, had difficulty with it in fact, by 4 years later I was starting to get symptoms that another 8 years on were diagnosed as Parkinsons, I have been treated for this, which did make a massive difference, since 2003. Three years ago my b12d was spotted, I am not getting the treatment I need, am pretty fed up about it as a year ago a 6 week trial got me on my feet again.

The problem seems to be that I appear to be ok, but actually I am not as anyone who visited me in my own habitat would swiftly understand. I can ust work myself up into appearing ordinary for he short time it take to get in through the doctors door.

There are chemical crossovers in the body during b12 synthesis and dopamine uptake, I often wonder if this is in fact the root of my problems, that in two of my pregnancies I had gas, the last was also a section, and that I live not just with the deficiency results of that, but also with a longterm difficulty with uptake. My doctors don't want to bother with testing me further, except for thyroid, which I have no signs of problems with. It would seem there is some kind of cognitive problem around b12, a blindness to the fact it exists outside of patients minds.

[Sleepybunny]

Hi All,

Sally Pacholok's book "Could it Be B12; An Epidemic of Misdiagnoses" mentions nitrous oxide as a cause of b12 deficiency in Chapter 9 with several case histories.

There is also mention on B12 deficiency leading to Parkinson type symptoms in Chapter 3 of the same book.

[Hidden]

I have had symptoms since infancy, but it was soon after some dental surgeries in childhood that I was whacked with the tiredness that never went away.

I wear a dog-tag-style medical alert pendant that reads on each side DO NOT ADMINISTER NITROUS OXIDE.

Be aware that clinical settings and commercially-prepared whipped cream and whipped toppings are not the only sources of potential exposure.  I understand canned cooking oil sprays typically have it as propellant (never use those sprays indoors!), and that there are nitrous oxide emissions from gas appliances and automobiles.