Entonox and PA

[LadyBothwell]

Hello. Yesterday I had a small procedure and was offered gas and air. I declined as I said I thought nitrous oxide was something not good for those with PA. i was due my b12 injection next day so was trying to hang on to anything left! The nurse said she had never heard such a thing and the doctor said I was ridiculous. The nurse came back and said she looked it up and I was right and thanked me saying she learned something. The doctor didn’t speak, I felt he was a bit extra rough with the procedure and it was certainly uncomfortable with no pain relief. So I was wondering if it actually would have made any difference if I had taken entonox.

[Nackapan]

The procedure might have been more comfortable.

Not sure if one use would do much harm. Shame about the timing of your injection

Doctor didn't sound very nice

[LadyBothwell in reply to Nackapan]

Ha ha. No he wasn’t. I was last appointment and he made me feel I was an irritant, after they asked me if I wanted to fill in a survey so I said yes and wrote a whole paragraph about my dissatisfaction with attitude. Nurse looked increasingly worried as I was typing on their iPad. I don’t suppose the doctor would change even if he sees it but it made me feel better. I also pointed out that she didn’t have to wait 45 mins with me because I didn’t have gas and air. 🤣

[Marymary7 in reply to LadyBothwell]

Well done you. Especially writing that review of their treatment and ignorance.

[Sleepybunny]

Hi,

Link about nitrous oxide

Nitrous Oxide

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

My understanding is that prolonged exposure inactivates majority of nitrous oxide in the body and it can then take a long time to build up levels in the body after exposure to it.

My personal view (I'm not medically trained) is that people with B12 deficiency whether PA or other cause should have a B12 jab following exposure to nitrous oxide. I'd love to know if any NHS trusts have this as their policy. or alternatives to nitrous oxide should be considered.

I sometimes think about all women who have gas and air as part of pain relief in labour ; low B12 is not uncommon in pregnancy to say nothing of new mums who might have PA or other cause of low B12. I suspect that exposure to nitrous oxide is a trigger of post natal depression in some women.

Interestingly, there is nothing on NHS Choices page about pain relief in labour, about problems with nitrous oxide for those with B12 deficiency. In fact it says there are no harmful effects for mother or baby...I beg to differ....

nhs.uk/conditions/pregnancy...

I have read of cases of sub acute combined degeneration of the spinal cord SACD after one exposure to nitrous oxide.

I've also read about dental nurses and midwives who have suffered after being continually exposed to small amounts of nitrous oxide.

Other articles about nitrous oxide

ncbi.nlm.nih.gov/pmc/articl...

ncbi.nlm.nih.gov/pmc/articl...

anesthesiology.pubs.asahq.o...

Blog post about midwives with B12 deficiency which mentions effects of nitrous oxide

midwifediaries.com/vitamin-...

[Hidden in reply to Sleepybunny]

Hi sleepybunny, yes I do believe gas and air during labour detrimentally affected two of my 3 kids. I breast fed all 3. No 1 & 3 were both very long labours - around 24 hrs so I used a LOT of entenox. They both have dyslexia. My eldest at age 22 ticked ¾ of Sally Pacholocks list of B 12 symptoms. Her active B12 was very low so she had injections. My youngest was also having some problems and had a low normal b12 level and now takes sublingual. No2 arrived after a very short and quick labour, no time for gas and air. He has no problems at all. Never got sick as a child unlike the other two and had no learning difficulties . My health after 1& 3 was rubbish, I felt terrible for a long time. Had weird heart problems after the first which finally went after year and half .

Do I think all these issues are a Coincidence? I think not.

When I discovered I was b12 deficient, it made me think of my mum who also had lots of symptoms . When she had me and my brother she had been fully anesthetized. Plus had recently had appendix and gallbladder removed. She had a stint in a mental institution along with ECT. I think a lot of her early health problems were B12 related too.

It’s very much in our family on both sides as my father in law has injections and my husband has also benefited greatly from supplements. We are not vegetarian either.

[fbirder in reply to Sleepybunny]

I was under the impression that it was not all the body's B12 that was inactivated by nitrous oxide, but all the circulating B12. And that the B12 stores in the liver remained intact.

Which is fine if you are a normal person with normal stores of B12 (four years worth) in the liver.

It is when your B12 levels are already pretty low that nitrous oxide can cause a calamitous drop in levels, because you've already depleted most of the liver stores.

I think that's what happened to me. I'd been showing symptoms of a deficiency (unrecognised by anybody) for years. Then I had a colonoscopy with Entonox. It was just after that I had a serum B12 test and it was undetectable. I think my B12 levels had had a slow leak for years and the nitrous oxide totally emptied the tank in one go.

As for doctors not knowing about it! It's been well known for over twenty years! thelancet.com/action/showPd...

[Sleepybunny in reply to fbirder]

Hi,

Thank you for clarifying that B12 stores are left intact.

I'm guessing that repeated exposure to nitrous oxide at short intervals would eventually deplete stores of B12 in the body though?

More articles about B12 deficiency and Nitrous oxide

adc.bmj.com/content/85/6/510.7

academic.oup.com/bja/articl...

There is a chapter in Sally Pacholok's book "Could it Be B12" that discusses effects of nitrous oxide.

[fbirder in reply to Sleepybunny]

I remember reading a study on occupational exposure to nitrous oxide (midwives maybe?) and they tested B12 and found no difference between them and controls.

Can't find it just now, and I'm a bit busy to look for it.

[Martin_12 in reply to Sleepybunny]

The anaesthetist who alerted me to the possibility that my peripheral neuropathy could be caused by B12 deficiency (after all I got from several neurologists at a neuromuscular clinic in a big Sydney hospital was puzzled expressions) told me that a few hours of nitrous oxide anaesthesia can destroy all B12 in the body, including all the liver stores. Nitrous oxide has a moderately high solubility in body fluids and gets into every cell in the body, including brain cells.

[Sleepybunny in reply to Martin_12]

Hi,

Thanks for that info. Do you have a link to any scientific articles that state that the liver stores of b12 are affected by nitrous oxide exposure?

This could explain much of what I suffered after childbirth;I used gas and air and had long labours.

Came across this article theorising that there may be links between nitrous oxide and autism

ncbi.nlm.nih.gov/pmc/articl...

[Martin_12 in reply to Sleepybunny]

Sorry I don't have any scientific articles proving or stating that N2O affects liver stores. If it didn't, patients who develop B12 deficiency symptoms would be expected to recover quite quickly after N2O exposure no matter how much exposure they had. All the articles I have read on this topic indicate affected patients need B12 shots to recover.

[Martin_12 in reply to Martin_12]

Some case studies:

ncbi.nlm.nih.gov/pubmed/259...

[Sleepybunny in reply to Martin_12]

There are blog posts on Martyn Hooper's PA blog about nitrous oxide.

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

[BirdlessBox]

I had nitrous oxide before I knew about it and it set me back terribly. I had just started injections and had some significant improvement and then much of it went backward and I had additional new problems too. I had been telling them I had a deficiency but no-one took any notice. I think I was on a threshold, as fbirder said "It is when your B12 levels are already pretty low that nitrous oxide can cause a calamitous drop in levels, because you've already depleted most of the liver stores." The reading I have done since indicates that it destroys all B12, not just circulating, don't know it is time dependant re length of exposure.

[fbirder in reply to BirdlessBox]

If it destroyed all B12 then you would expect everybody who gets it to suffer from severe symptoms of a deficiency. The fact that you do not suggests that lots of B12 is unaffected.

I've had a look at several papers about recreational use of N2O and B12.

pn.bmj.com/content/15/3/207

ncbi.nlm.nih.gov/pmc/articl...

ncbi.nlm.nih.gov/pmc/articl...

Three out of the five case studies had 'normal' serum B12 and one was close enough for many doctors to decide it wasn't low enough to cause their symptoms.

[Nick421 in reply to fbirder]

Nitrous inactivated b12 it doesn’t drain it. You could have a serum b12 if greater than 1000 but the test doesn’t differentiate between cobalamin I or cobalamin II or III

[fbirder in reply to Nick421]

Reference?