The Dangers of Inhaling Nitrous
by Matt Baggott
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First, there are the dangers which accompany the inhalation of any
compressed gas (making sure you get enough air, making sure you don't freeze
your lips or inflate your head, making sure you are sitting down and
won't hurt yourself if you get dizzy).
Second, there are the health effects specific to nitrous oxide. There have
been reports of immunological and reproductive disturbances in professionals
who are chronically exposed to nitrous oxide. The immunological
disturbances are documented by Peric et al (1991) _Anaethesia_ 46: 531-7.
Apparently anaesthetic personnel had been complaining about
weakness and recurrent infections and decreased peripheral blood
leukocyte counts has been found. The operating rooms were found to
be improperly ventilated, causing nitrous oxide and halothane (another
anaesthetic) to remain in the air. Even after a 3-4 week holiday,
some personnel has decreased B lymphocytes and increased red cell count,
haemoglobin concentration and haematocrit and other disturbances.
I don't have a reference handy for the reproductive disturbances, but the
study basically found that women who were chronically exposed to
nitrous had difficulty becoming pregnant. It should be noted that these
health effects are the result of CHRONIC exposure; a single balloon at
a Dead show (or a single visit to the dentist) is unlikely to be a problem
for a healthy individual.
Aside from its psychopharmacological actions, nitrous oxide has one other
(known) significant metabolic action: it interacts with vitamin B12. This
was first reported in an in vitro study in 1968, but didn't really
receive notice from anaesthesiologists until ten years later (because
medline didn't exist yet :-) ). In 1978, however, Amess et al showed that
24 h of nitrous oxide administration caused interference with DNA
synthesis in humans. Since then, the interaction between nitrous oxide
and B12 has been better characterized.
Basically, B12 is a bound coenzyme of methionine synthase and has a
tetrapyrrole rings with a monovalent cobalt at the center. The cobalt
functions as a methyl carrier in a transmethylation reaction. Nitrous
oxide converts the cobalt from the monovalent form to the bivalent
form. As a result, methionine synthase activity is inhibited. Recovery
is believed to require absorption of new unoxidized B12 (and synthesis
of new apoenzyme).
Humans seem to be far more resistant to complications from this than rodents.
I don't have the energy to go through the various published studies at
this point, so I will quote from Nunn's "Clinical Aspects of the Interaction
Between Nitrous Oxide and Vitamin B12" (1987), _Br. J. Anaesth._ 59: 3-13.
It seems likely that in man, in contrast to the rat, exposure
of less than 30 minutes will not cause any measurable change in
methionine synthase activity. In combination with a wealth of
clinical experience, this suggests that there is no special
hazard for short exposures to nitrous oxide. There is a variable
response to exposures lasting between 30 minutes and 2 h. However,
it now seems likely that exposures of more than 2 h are likely
to cause intereference with hepatic methionine synthase
activity. The paucity of human data makes it more difficult to
say how long an exposure is required to cause significant
intereference with DNA synthesis. It is likely that there will
be considerable individual variation and results obtained in
healthy patients cannot be extrapolated to the patient
who is seriously ill. Nevertheless, it seems likely that,
once methionine synthase activity is inhibited, it will remain
so for days.
With respect to repeated exposures to nitrous, be aware that this effect
can build up (Nunn gives "intervals of less than 3 days" as a cut-off).
So, go easy on the "hippie crack," people!
Mandatory nitrous horror story: Layzer (in (1978) "Myeloneuropathy after
prolonged exposure to nitrous oxide," _Lancet_ 2:1227) reports a case of
15 people who had been inhaling nitrous oxide for long periods of time
and developed a condition resembling subacture combined degneration of
the cord, whatever that means.
I would suggest that the following types of people in particular avoid
exposure to signficant amounts of nitrous:
Pregnant women: since nitrous oxide is a known teratogen in rodents,
acting by depleting folates and partially reversible by oral
folinic acid, we can expect a similar syndrome in humans.
Vegans who don't take B12 supplements: although documented cases of
vegans with B12 decifiencies are scarce, theories on nutrition
indicate that vegans are unlikely to get as much B12 as other
groups of people.
Individiduals with healing wounds, infections, or immunological
disorders: I'm throwing this recommendation in based on a "better
safe than sorry" policy. Short-term exposure to nitrous oxide
is unlikely to be a problem, but why not play it safe?
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