Nitrous Oxide-Induced Pancytopenia and Peripheral Neuropathy From Chronic Whip-It™ Use: A Case Report

Nitrous oxide (N2O) is a colorless, odorless gas gaining popularity among recreational drug users for its euphoric effects. Whip-it!™ is a low-cost, freely available form of N2O commonly abused in parties and nightclubs. Chronic N2O use can inactivate vitamin B12, causing severe deficiency, anemia, neuropathy, and myelopathy. Here, we report a 19-year-old female with no significant past medical history who was found unresponsive in her apartment. She admitted to daily Whip-it™ use over the preceding three months. In the emergency department, she reported generalized weakness and tingling in all extremities. Workup revealed pancytopenia and profound vitamin B12 deficiency. She was treated with vitamin B12 supplementation and blood transfusions, with significant symptom improvement by discharge. N2O inactivates vitamin B12 through irreversible oxidation of the cobalt atom, causing deficiency and neurologic injury. Unlike other classic causes of vitamin deficiency, such as a vegan diet or pernicious anemia, N2O-induced anemia can occur very rapidly (within days or weeks). Clinicians should consider recreational N2O use in young patients presenting with cytopenias and neurologic symptoms. Given its easy availability and rising misuse, public health education to raise awareness is needed.