Assessing the prevalence of nitrous oxide usage in patients aged 35 years or under presenting with unprovoked VTE between 2021-2023

Abstract

Background

Nitrous oxide (N₂O), often known as "laughing gas," ranks as a widely used recreational drug among young people in the UK, with 3.9 % of young adults aged 16–24 reporting its use in 2021–2022. Besides its known neurological risks, there is emerging evidence linking N₂O misuse to serious haematological issues, including arterial and venous thrombosis.

Aims/objectives

The project aimed to elucidate the prevalence of N₂O usage in young adults (18–35 years) with unprovoked venous thromboembolism (VTE) between January 2021 and July 2023.

Method

Patient records from three East London emergency departments (ED), coded with a SNOMED code for VTE upon ED discharge between January 2021 and June 2023, were compiled using Qliksense. The data extracted from electronic patient records (EPR) encompassed demographics, confirmed cases of VTE at discharge, and history of N₂O usage. Criteria for exclusion included age restrictions, established provoking factors for VTE, and unconfirmed reports of N₂O use.

Results

We found 26 patients, out of which 8 patients (31 %) reported N₂O use. Among these, a majority of 7 patients (88 %) reported regular N₂O at the time of admission for VTE. Furthermore, 6 patients (75 %) reported regular N₂O use for at least 12 months. The quantity of N₂O usage varied widely, ranging from 7 to 210 (mean = 61.9, ∼495g) small canisters per week with each canister containing 8 g of N₂O. The duration of N₂O use varied significantly ranging from 7 to 59 months (mean = 29.25). This group of young adults (18–35; mean = 25) was 88 % male and 12 % female. The ethnic distribution among the cohort was 62 % Asian or Asian British, 25 % Black or Black British, and 12 % White. Stratified by the index of multiple deprivation 25 % were in quintile 1–2, 50 % were 3–4, 12 % were 5–6, and 12 % were in 7–8 range (0 % 9–10).

Conclusion

Healthcare providers, particularly those in Acute Medicine and EDs, should consider implementing VTE screening protocols for young adults aged 18–35 presenting to ED with reported N₂O misuse and neurological problems. A thorough assessment of N₂O usage patterns is essential, alongside the provision of culturally sensitive health education that addresses the unique needs of marginalised communities. Ongoing research is necessary to elucidate the pathophysiological pathways connecting N₂O use to VTE incidents, particularly its link to increased homocysteine levels.