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Nitrous Oxide: Can You Overdose? How Much Is Lethal?

nitrous-oxide-overdoseNitrous oxide (N2O, which is commonly referred to as laughing gas) was discovered in the late 1700s and has been used medicinally for many years. It is a small inorganic chemical that has numerous uses in addition to its medicinal uses. It is often used in the food processing industry, the semiconductor industry, and even for car racing. Nitrous oxide is also considered to be a pollutant, as it is a byproduct of combustion.

Because it is a gas, nitrous oxide is primarily absorbed through the lungs. It has an extremely fast half-life of approximately five minutes, and it is primarily eliminated through breathing.

Nitrous oxide is also abused by individuals who inhale the fumes through various sources, including through various food dispensing agents like commercial whipped cream dispensers (called “whippets”) and other similar containers. Replacement nitrous oxide containers for these commercial grade items are readily available and not illegal to own. In addition, nitrous oxide is contained in many over-the-counter products that can readily be purchased at a local store, such as vegetable spray, cooking sprays, etc.

According to the Handbook of Pharmaceutical Excipients, some of the medicinal uses of nitrous oxide include:

  • For anesthesia during surgical procedures, especially with dental surgery
  • For chronic pain relief, such as pain associated with different forms of cancer
  • For children receiving injections for arthritic pain
  • For other minor medical procedures

 The gas is considered to be relatively safe with only a few contraindications.

  • It should not be used in individuals with severe respiratory issues.
  • It should not be used in individuals who have had eye surgery that uses an intraocular gas.
  • Caution should be exercised in its use in individuals with a history of cardiac problems, stroke, or issues with vitamin B12 deficiency.

Toxicity


Nitrous oxide abuse is a significant issue. As mentioned above, it can be found rather easily, and there is no specific age limit for purchasing containers of nitrous oxide that are often referred to as whippets, cream chargers, etc. Moreover, individuals can buy cans of products that contain nitrous oxide, such as whipped cream, in a grocery store and inhale the gas.
The apparent psychoactive effects associated with nitric oxide abuse include:

  • Extreme feelings of euphoria
  • Becoming more abstract or experiencing periods of “deep thinking”
  • Increase in feelings of happiness
  • A mild rush of energy
  • Loss of inhibitions

Some of the negative issues that can occur include:

  • Dizziness
  • Dissociation (feeling as if one is not attached to one’s body or that one is not real)
  • Irrational thinking and problems with judgment
  • Unconsciousness and/or coma

Due to the substance’s extremely short half-life, the psychoactive effects are relatively brief, intense, and often lead to individuals bingeing repeatedly on the gas to maintain the effects. The use of nitrous oxide is not believed to cause physical dependence, but it may result in emotional or psychological feelings of dependence, such that individuals may feel the need to use it to cope with stress, feelings of anxiety, or everyday issues they face.

Several issues are associated with toxicity as a result of taking nitrous oxide for too long or in large amounts.

  • Nitrous oxide interacts with the ability of an individual to synthesize vitamin B12, and long-term exposure to nitrous oxide can cause issues with the production of bone marrow or lead to neurological symptoms.
  • Prolonged exposure can result in issues with hypoxia or anoxia (reduced oxygen flow to the brain or other organs or a total stoppage of the flow of oxygen). This can lead to significant issues with brain and other organ damage.
  • Because nitrous oxide is a gas, there are no specific doses that are associated with an overdose or toxicity. Instead, issues with toxicity are most often due to long-term exposure to the gas and decreased oxygen consumption.

Certain individuals who work in occupations where nitrous oxide may be more commonly inhaled, such as welders, firefighters, military personnel, etc., are at risk for issues associated with long-term exposure as are chronic abusers of the substance. Nitrous oxide may also be a byproduct of organic material, such as corn and other grains. If these are stored in silos and ferment, farmers may be at risk for chronic exposure.

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Overdose Signs and Research


Signs of toxic exposure, including overdose, include:

  • Irritation in the eyes, nose, and/or throat
  • Wheezing or worsening cough
  • Seizures or significant respiratory depression, which can be fatal
  • Choking or tightness in the chest
  • Headache, lightheadedness, or dizziness
  • Shortness of breath (dyspnea)
  • Bluish fingers, toes, or lips
  • Rapid heart rate, changes in blood pressure, and potential heart attack or stroke
  • Psychosis (hallucinations and/or delusions)

Again, this is a gas, so there are no recommended or specified doses associated with toxicity or overdose. The World Health Organization (WHO) has set standards for the safe amount of nitrous oxide that should be considered in both chronic and acute exposures (acute exposure being for the use of medicinal reasons and not designed to specify exposures associated with recreational abuse of the substance).

 For chronic exposure to nitrous oxide, it is recommended that the maximum exposure be 20 parts per billion (expressing a ratio between nitrous oxide and breathable air), and for acute exposures, no more than 100 parts per billion for one hour.

Individuals who abuse nitrous oxide by inhaling containers of it easily exceed this safe ratio and can experience toxic and overdose effects after several minutes of continued exposure; however, because of the drug’s short half-life, overexposure to nitrous oxide would expected to significantly dissipate once the person stops breathing in the substance and breathes air. Continuing to inhale the substance for more than several minutes can result in significant toxic issues. Chronically abusing nitrous oxide (continuing to inhale it on a regular basis) can lead to serious chronic issues that could present as toxic exposure.

Death could conceivably occur in individuals who experience significant brain damage as a result of the lack of oxygen to the brain if they inhale very concentrated amounts of nitrous oxide and do not breathe sufficient amounts of oxygen.

A review of the available case studies in a research article in the American Journal on Addictions reported in 2016 indicated the following:

  • There were 29 fatal cases associated with abuse.
  • Fatalities were often associated with neurological issues.
  • There were 11 cases of reported psychosis associated with abuse.
  • Numerous other health issues were associated with abuse of nitrous oxide.

The authors concluded that due to difficulty medically recognizing toxicity associated with nitrous oxide abuse, this represents a significant issue. Clinicians should become familiar with the symptoms in order to be able to recognize them.

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