"Laughing gas" - the renowned inhaled drug

"Laughing gas" - the renowned inhaled drug

Oral presentation

Ralitsa Zlatanova1, Stanimir Tepavski2, Kiril Zhelev2, Rositsa Kostandieva3, Yana Goranova4, Silviya Stoykova1,3, Vasil Atanasov1,3;
1Sofia University "St. Kliment Ohridski", Faculty of Chemistry and Pharmacy, Department of Analytical Chemistry, Laboratory of Biocoordination and Bioanalytical Chemistry, Sofia, Bulgaria
2Military Medical Academy, Department of Toxicology, Emergency Toxicology Clinic, Sofia, Bulgaria
3Military Medical Academy, Department of Toxicology, Forensic Toxicology Laboratory, Sofia, Bulgaria
4Military Medical Academy, Department of Virology, Microbiology, Clinical Laboratory and immunology, Sofia, Bulgaria;

Nitrous oxide, also known as “laughing gas” was first synthesized in 1775. It is a gas, which is colorless at room temperature, non-flammable and with a sweet odor. It used to be utilized as an anesthetic and analgesic in human and dental medicine, especially during interventions requiring short-term anesthesia. Even in the past it was used as a recreational substance due to its euphoric, pleasurable and hallucinogenic effects. What made nitrous oxide so widespread was its low price and the fact that it was easily accessible. It soon became one of the most abused legal drugs. It is usually consumed by inhaling the gas from a pre-filled balloon (the balloon is most commonly filled from a capsule, in which the gas is compressed). A series of cases have been reported, testifying to its harmful effects with such intake. Its mechanism of action on the nervous system not yet fully understood which hampers medical service in case of an emergency. Literature data points out that there is a correlation between regular usage of “laughing gas” and decreased serum levels of vitamin B12 (cyanocobalamin). It is assumed that nitrous oxide leads to oxidation of the metal ion Co(I) to Co(III) in the cyanocobalamin molecule. Chronicle abuse of nitrous oxide may lead to megaloblastic anemia, thrombocytopenia, leukopenia, peripheral neuropathy and myelopathy similar to the effects of vitamin B12 deficiency. The aim of this report is to address the supposed mechanism of action and the toxic effects of "laughing gas", as well as the possibilities of symptomatic treatment.
Keywords: laughing gas, intoxication, toxicodynamics, cyanocobalamin