Is Nitrous Oxide Poisonous and Can You Overdose on It?

Commonly known as laughing gas, nitrous oxide is a chemical compound (chemical formula: N₂O) with various uses, especially in surgical procedures, dentistry, and the food industry. However, this gas is gaining popularity for a not-so-funny use: as a recreational drug.

'Galaxy Gas' is gaining attention on social media and recent news as a flavored nitrous oxide sold in metal canisters. However, is this gas poisonous, and can you overdose with it? Let's clear the smoke screen and uncover the truths about nitrous oxide gas.

What is nitrous oxide?

Nitrous oxide, commonly known as laughing gas, is a non-flammable, odorless, and colorless gas. It is commonly found in metal canisters and sometimes balloons, and it has several medical uses — especially in anesthesia and pain management — and in other industries like the food and automobile industries.

Uses of nitrous oxide

In medical practice (particularly for general anesthesia and dental anesthesia), inhaling nitrous oxide (i.e., laughing gas) through a standard face mask is safely and effectively used for pain relief. Healthcare professionals like dentists use nitrous oxide to sedate people who are having minor medical procedures; other medical professionals use this gas to provide pain relief during childbirth. However, nitrous oxide use can be applied to treat people who are withdrawing from alcohol dependence.

Beyond its medical use, nitrous oxide is used in the food industry in whipped cream and in the racing industry as a fuel booster to boost the performance of car engines.

In recent times, beyond its use in these relevant industries, nitrous oxide is commonly abused (usually by young adults) as a recreational drug. This gas, sometimes referred to as 'whippets' (sold in silver canisters), is a very commonly used recreational drug in the United Kingdom and the United States — a study showed it is used by up to 38% of the population.

Recreational nitrous oxide use is due to the main nitrous oxide effects:

• A sudden surge of euphoria
• Increased consciousness
• Feelings of floating
• Disassociation

These effects last for around 1 minute.

How does nitrous oxide work?

When inhaled, nitrous oxide is rapidly absorbed into the bloodstream through pockets (known as alveoli) in the lungs. Nitrous oxide works by specifically binding to receptors in the brain and spinal cord (both of which are part of the central nervous system). Specifically, it blocks NMDA (N-methyl-D-aspartate) and GABA-A (gamma-aminobutyric acid) receptors. The effects of nitrous oxide on NMDA receptors are what cause the anesthetic effects, and the effects of nitrous oxide on GABA-A receptors are what cause the calming effects.

Nitrous oxide gas quickly passes across the lining of the alveoli, providing it with a rapid onset (15–20 seconds) of action as it quickly reaches the central nervous system. After nitrous oxide affects the parts of the body that it needs to, it is quickly eliminated (after approximately 10–15 minutes) from the body through the alveoli. This combination of rapid onset of action and short-duration effects makes nitrous oxide attractive for medical applications.

Can you overdose on nitrous oxide?

Nitrous oxide misuse is the most common type of inhalant misuse. A 2019 survey by the U.S. Substance Abuse and Mental Health Services Administration found that the lifetime prevalence of nitrous oxide misuse by Americans aged 12 and older was 4.6% (12.65 million).

Because nitrous oxide is a gas, there are no specific doses of it that are associated with an overdose. As a result of this, overdoses are usually due to long-term (i.e., chronic) exposure to it, which results in reduced oxygen consumption.

When it is used for anesthesia in medical environments, nitrous oxide is usually administered together with oxygen in a 70:30 ratio. At higher concentrations than this, nitrous oxide overdose can occur. This overdose could result in hypoxia (i.e., oxygen deprivation). A 2011 publication reported a severe case of death potentially caused by an addictive inhalation of nitrous oxide.

Furthermore, long-term exposure to nitrous oxide could cause vitamin B12 deficiency, leading to paraparesis (the partial weakness of the lower half of the body, usually the legs).

Symptoms of nitrous oxide overdose

The symptoms of nitrous oxide overdose can vary in severity but they often include physical and neurological signs. These include the following:

• Dizziness
• Dissociation
• Loss of balance
• Weakness in the legs
• Impaired memory and cognition
• Hypoxia
• Numbness in limbs

Is nitrous oxide poisoning possible?

Yes, it is! Above the usual nitrous oxide-to-oxygen ratio of 70:30, nitrous oxide poisoning can occur.

At high concentrations, nitrous oxide travels out of the blood and into the alveoli, causing hypoxemia (abnormally low oxygen levels in the blood), coma, and death. Long-term exposure to this gas permanently causes a crucial component of the cobalt in vitamin B12 to break down, causing the vitamin to lose its biological function and leading to severe neurological and blood-related toxicity.

The signs and symptoms of laughing gas poisoning are similar to the signs and symptoms of its overdose, as listed above.

Recent news and concerns about Galaxy Gas

A recent product, Galaxy Gas, is marketed as nitrous oxide in tanks that are filled to Food and Drugs Administration (FDA) standards. Galaxy Gas was primarily created for culinary purposes, as chargeable whipped cream dispensers. However, they are being misused outside of their intended purposes.

In addition to the growing concern among health professionals (mentioned above) about its recreational misuse, Galaxy Gas has released a disclaimer on their website stating: "The sale of whip cream chargers for the purposes of inhalation is illegal. Under no circumstances does Galaxy Gas condone and/or permit this manner of use."

Precautions to take when using nitrous oxide

Nitrous oxide should only be used in a medical or medically controlled environment, by healthcare professionals. When it is used, it should be with proper oxygen supplementation, ideally in a 70:30 ratio. To protect people, medical professionals make every effort to prevent toxic exposure.

Avoiding misuse and overdose

Any recreational use of nitrous oxide should be avoided. With the growing concern for the rise in its misuse and overdose, inhaling nitrous oxide from canisters or balloons has very dangerous outcomes.

This gas should never be used in enclosed spaces without proper ventilation. This is because enclosed spaces may not contain enough oxygen to breathe properly; a build-up of nitrous oxide in enclosed spaces could cause oxygen deprivation in the body, potentially leading to brain injury and/or death.

Who's at risk?

To put it simply, everyone who uses nitrous oxide recreationally is at risk. Certain groups of people could be at increased risk of nitrous oxide misuse and overdose. Because nitrous oxide's main route of entry after it is inhaled is through the lungs, people with a medical history of respiratory issues are at a higher risk of complications. When inhaled, nitrous oxide is rapidly absorbed into the bloodstream through pockets (known as alveoli) in the lungs.

Frequent recreational users are at higher risk of long-term health effects, including nerve damage and paraparesis. The outcomes of a Global Drug Survey that was published in 2020 showed that people who are heavy users of this gas are at a dose-dependent risk of developing serious neurological complications.

Signs you should seek medical attention

If you or someone experiences difficulty breathing or loses consciousness after using nitrous oxide, seek immediate medical help. Call an ambulance immediately.

Some indications of nerve damage caused after using laughing gas include numbness, weakness, dissociation, or difficulty walking due to weakness.

Not a funny matter: laughing gas has serious consequences

When it is used beyond its medical and culinary purposes, nitrous oxide can be dangerous. This misuse of this gas welcomes the potential for overdose and poisoning. There is growing concern about its misuse and overdose due to the rise in its recreational use, causing serious side effects ranging from dizziness to death. Nitrous oxide should only be used under medical supervision.

It is important to stay informed and cautious when it comes to nitrous oxide and its misuse. This is especially important because products like 'Galaxy Gas' (nitrous oxide sold in canisters) are becoming more readily available and accessible.