Document resource
Nitrous oxide (N 2O) use has risen sharply over the last decade, becoming the second most commonly used recreational drug in the UK. The association between N2O use, functional vitamin B12 deficiency, and neurological complications is now well recognised. Early diagnosis and treatment are crucial to prevent permanent disability in the young. The Noyce group recently published guidelines for the management of N2O-induced myeloneuropathy, recommending functional B12 testing, urgent spinal MRI, and rapid intramuscular B12 replacement. These guidelines have been successfully integrated into the UCLH Acute Medicine pathway, and cases are referred to the Neurology Same Day Emergency Care (Neuro SDEC) service at University College London Hospital (UCLH).Consensus regarding post-acute management of these patients is lacking and the prognosis is still poorly understood. Although the recommendation is to refer to a General Neurology clinic, in practice this does not provide timely input and patients with residual symptoms have ongoing care needs. This project aims to present our experience of N2O-induced myeloneuropathy patients seen within our Neuro SDEC service at UCLH from 2020 to 2025, and also introduce a local post-acute management pathway to help guide the practising neurologist.harry.knights1@nhs.net