A Case of Subacute Combined Degeneration Secondary to Recreational Whippet Use

‘Whippets’ or nitrous oxide (N(2)O) abuse is a rare etiology of B12 deficiency and subacute combined degeneration (SCD). Often used in the medical field as an anesthetic, recreational use has rapidly increased given its euphoric effects. Easy accessibility over the counter at local stores due to the fact that it has bacteriostatic effects useful for canisters of creams and perishable goods. This makes N(2)O, or “laughing gas,” easy to obtain. Long-standing abuse of N(2)O can lead to deleterious effects on the central nervous system, including SCD, polyneuropathy, and death. Presentation includes frequent falls, ataxic gait, weakness in the lower extremities, and neuropathy. Herein, we present a case of a 25-year-old male with no past medical history presenting with SCD in the setting of longstanding recreational whippet use. Our case highlights an important consideration for all specialties, including emergency medicine, psychiatry, family medicine, and internal medicine physicians.