Robert Riezebos of the Heart Center of the OLVG and cardiologist and chief de clinique Remko Kuipers sound the alarm about the drug that many young people mistakenly still regard as relatively harmless.
“Until last year, as cardiologists, we never saw any problems with the use of laughing gas as a party drug, but in just over a year we had to treat five young patients for serious cardiovascular problems. Young men and women between the ages of 20 and 30, ”says Riezebos. “They had used laughing gas the way others drink binge. The blood clots caused by excessive use of nitrous oxide can cause a heart attack. We notice that these heart attacks are sometimes difficult to treat, because the blood clots appear firmer than usual. They are less easy to treat with regular angioplasty or with blood thinners. ”
Hundreds of balloons
The serious heart attacks appeared to be caused by the users inhaling the gas for hours to sometimes two days at a time. Hundreds of balloons sometimes. One of them had freeze wounds on the inside of his legs, between which he had clamped the ice-cold laughing gas tank. He hadn’t felt anything.
“Our vascular surgeons treated a case in which the patient had thrombosis in an artery of his leg after using balloons containing nitrous oxide all night. This eventually led to so many complications that his leg had to be amputated, ”says Riezebos. “It is a shame that people in their twenties end up in these serious, sometimes life-threatening problems pointlessly. Even if they survive, a scar on the heart remains a scar. ”
“We also see young people at the OLVG with pulmonary embolisms after using nitrous oxide. These clots in the pulmonary arteries can sometimes be life-threatening. Of the two boys with nitrous oxide lung embolism we treated this year, one will recover, but the other is likely to have lifelong problems. ”
Cardiologist Kuipers has now analyzed all cases in which patients ended up in OLVG East or OLVG West after extreme use of laughing gas. In addition to cardiologists, he also approached emergency and intensive care doctors, vascular surgeons and pulmonologists and dug into the literature.
B12 deficiency
“The problem can be explained by the vitamin B12, which creates a dangerous shortage due to the extreme use of laughing gas,” says Kuipers. “This deficiency increases the level of homocysteine in the blood, which can cause the blood to clot. This then results in thrombosis. In some men who had used a lot of nitrous oxide, the level of homocysteine in the blood turned out to be sky-high as a result of this deficiency. In one patient it was 40 times higher than normal, while we are sometimes already concerned at a fraction of that because of the blood clots it causes. ”
This problem was not yet known to doctors and experts – other than the neurological damage caused by excessive use of nitrous oxide to the spinal cord, resulting in paralysis and even spinal cord injuries.
“Patients are not always honest about their drug use and counselors don’t always keep asking questions, so we probably don’t see some of the problems,” says Kuipers. “Many care providers are also not aware of the dangers of nitrous oxide or think that nitrous oxide cannot be measured. The latter is in itself the case, but the consequences of extreme use of laughing gas can perhaps be measured, if we look at the content of vitamin B12 or homocysteine. We are now investigating how reliable these measurements are for nitrous oxide use. ”
Due to the lockdown due to corona, the use of certain party drugs has decreased, but within the OLVG they are concerned about the use of laughing gas at home and the developments when the nightlife gets going again. Riezebos: “We really hope that the recreational use of laughing gas will be banned, because it destroys young lives. The consequences can be so great and permanent, and it seems like waiting for the first death. ”
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