The Toxicology committee has developed a new Nitrous Oxide misuse CPG.

The Key points for the CPG are

1. Chronic high-level recreational N₂O exposure impedes vitamin B12 function, leading to neurological dysfunction and rarely myelosuppression
2. Patients often present with symptoms and signs consistent with subacute combined degeneration of the spinal cord
3. Measured vitamin B12 may be normal and does not reflect ‘functional vitamin B12’ concentration
4. Discontinuation of N₂O and administration of intramuscular vitamin B12 and oral methionine are the mainstays of management