Trombo-embolieën door recreatief lachgasgebruik

Nitrous oxide (N₂O) is increasingly used as a recreational drug, and is presumed relatively safe and innocent. The risks for neurological complications are often known, however the risks of serious thromboembolic events are not.

We describe three cases of acute thromboembolic events resulting in serious cardiovascular complications after N₂O abuse: one case of myocardial infarction that resulted in a reduced ejection fraction, one case of peripheral arterial occlusion that led to limb amputation and one case of pulmonary embolism that resulted in hemodynamic instability requiring extracorporeal membrane oxygenation (ECMO) and surgical removal. All patients were young adults with a low cardiovascular risk profile.

N₂O inactivates vitamin B₁₂, leading to vitamin B₁₂ deficiency and subsequent to hyperhomocysteinemia, which is associated with the formation of fibrinolysis-resistant blood thrombi.

In conclusion, we contest the safety and innocence of recreational N₂O (ab)use. Our three cases illustrate that, next to previously described neurological complications, the use of nitrous oxide is associated with thromboembolic cardiovascular complications, presumably mediated by hyperhomocysteinemia.

Conflict of interest and financial support: none declared.