A chilling risk of recreational nitrous oxide use: Frostbite

The recreational use of nitrous oxide – often called whippets or Lighing Gas – has left a 23 -year -old with frostbite in the mouth and throat, according to a report from the case of man published Wednesday in the New England Journal of Medicine.

The recreational use of nitrous oxide has increased in recent years: data from American poison centers show an increase of almost 60% of intentional exposure reports to the drug from 2023 to 2024. The Food and Drug Administration has published several warnings which advise people to inhalation of nitrous oxide products, which are often marketed to be used to make floating cream.

The frostbite occurs when ice crystals form in the skin and deeper tissues, damaging cells and disturbing blood flow. Dr. Michael Patrizio, assistant director of active care at the University of Virginia, said that obtaining frosts in the mouth and the throat by inhaling nitrous oxide is rare, but not unknown.

The patient told Patrizio that his painful swallowing and wrapping started immediately after inhaling the nitrous oxide directly from a cartridge two days earlier. White stains – The frozen fabric – swollen on the roof of his mouth, throat and throat.

“If he had not been to come with this information, it would probably not have been something that crossed my mind,” said Patrizio, who saw the man at the campus ambulatory clinic and was co-author of the case report. “I would have thought of a viral infection – Mono, a Streptococcal gorge – or an STI in the throat.”

When a compressed gas expands, it can cool to less than 40 degrees Fahrenheit – which is why compressed gas is used to cool the refrigerators. Nitrous compressed oxide cartridges work in the same way. When the gas is released, it cools, sometimes radically.

“This has the potential to cause frostbite,” said Dr. Cara Borelli, medical doctor from drug addiction at the University of Yale, in an email. Borelli was not involved in the patient’s case.

Surgeons use nitrous compressed oxide to make ablations, a procedure that uses extreme cold or heat to eliminate tissues.

“If you have someone who uses drugs in an uncontrolled setting, you could certainly damage the tissues you do not want to damage,” said Dr. Jeffrey Ruwe, an emergency medical doctor at the Cleveland Clinic who was not involved in the case of the man.

Overall, the cases of frostbite from nitrous oxide cans are rare, although they are probably under-declared, said Patrizio. More frequently than in the mouth and throat, the consumption of illegal nitrous oxide leads to frost burns on the thighs and hands, because people hold refrigerated cartridges and fill balloons with the gas, which allows gas to warm up before people inhale it.

The frostbite can be serious – at least several people required skin transplants and surgery due to nitrous oxide burns on their legs and hands – but it is not really the risk that people think, “said Patrizio.

The most common risks to use recreational nitrogen oxide include a broken lung, overly deep inhalation of gas and a lack of oxygen in the brain, he said. It can also cause vitamin deficiencies that can cause potentially fatal neurological problems.

“Nitrous oxide inactive vitamin B12, which means that B12 of the body does not work as it is supposed to do,” said Borelli.

The body uses vitamin B12 to synthesize myelin, a substance made of fats and proteins that surround and isolates the nerves. If this sheath decomposes, it can cause serious neurological problems. After chronic use, nitrous oxide can cause changes in nervous system and brain that can move from weakness and instability to paralysis.

“It’s very real,” said Ruwe.

Patrizio told his frosted patient to use over -the -counter pain drugs, lidocaine and steroid paste to reduce inflammation and swelling while her frostbite healed.

Ruwe said it may not have been the case for everyone.

“The frightenings are very, very rare, but if they are inhaled directly from a high pressure tank, or if it causes swelling of the airways, this could be sensitive to time and potentially deadly,” he said.