Why the study?
Chronic recreational nitrous oxide use is a potentially under-recognised provoking risk factor for pulmonary embolism via elevated serum homocysteine levels.
Does chronic recreational nitrous oxide use provoke pulmonary embolism in young adults?
Does chronic recreational nitrous oxide use provoke pulmonary embolism in young adults?
Chronic recreational nitrous oxide use may be an under-recognized provoking factor for pulmonary embolism in young adults, likely mediated by elevated homocysteine levels.
May warrant asking young PE patients about nitrous oxide use; leaves open a causal role pending further evidence.
Pulmonary embolism (PE) is a common acute presentation which may be provoked by multiple factors. We present the unique case of a young man with no underlying health conditions who was diagnosed with bilateral PE which we believe was provoked by chronic use of nitrous oxide (NO), a potentially under-recognised risk factor for PE. NO is a substance that is commonly used recreationally, particularly among young adults in the UK. It has been shown to increase serum homocysteine levels which may create a prothrombotic state.Our patient had raised serum homocysteine levels on admission. He was anticoagulated and discharged with advice to stop nitrous oxide use. We recommend asking patients about recreational drug use when screening for provoking factors for PE so as to offer appropriate treatment and counselling.
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Shah et al. (2022) studied this question.
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