SHM Converge Scientific Abstract ePoster Gallery-Whipped by Whippets: Beyond the First Diagnosis

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This case describes a 22-year-old woman who presented with hallucinations, confusion, jaundice, pancytopenia, and neurologic findings including ataxia, dysmetria, and loss of vibratory sensation. Her friend reported heavy recreational nitrous oxide (“whippets”) use, escalating to multiple cans per day, with evidence of extensive use at home. Initial labs showed severe vitamin B12 deficiency, indirect hyperbilirubinemia, low haptoglobin, elevated LDH, and macrocytosis with abnormal red cell morphology, consistent with ineffective erythropoiesis and hemolysis-like findings.<br /><br />Because nitrous oxide can inactivate B12 and cause functional deficiency, it was an important suspected cause of her neuropsychiatric and hematologic abnormalities. However, further evaluation revealed positive parietal cell antibodies, supporting an additional diagnosis of pernicious anemia. Intrinsic factor antibodies were negative, but the autoimmune process was still felt to contribute to impaired B12 absorption. Thus, her presentation reflected a combination of recreational nitrous oxide exposure and underlying autoimmune B12 deficiency.<br /><br />She was treated with high-dose intramuscular vitamin B12 and improved rapidly, particularly in mental status. She was discharged with ongoing B12 supplementation and follow-up.<br /><br />The key message is to avoid diagnostic anchoring after identifying a single explanation. In patients with severe B12 deficiency, especially young adults with neuropsychiatric symptoms, clinicians should consider both functional causes such as nitrous oxide exposure and classic causes such as pernicious anemia. Early recognition and treatment are crucial to prevent potentially irreversible neurologic and hematologic complications.

Asset Subtitle

Dennis P. Kurian

Meta Tag

Author List Dennis P. Kurian

Category Clinical Vignettes

Distinguished Non-Finalist

Presenter Organization NYU Langone

Presenting Author Dennis P. Kurian

Track Adult

Keywords

nitrous oxide abuse