Neurological manifestations of vitamin B12 deficiency
ICD-10 D51.9 · ICD-11 8A45.30

Neurological Manifestations of Vitamin B12 Deficiency Caused by Recreational Nitrous Oxide Use

Recreational nitrous oxide use is a recognised cause of vitamin B12 deficiency. When neurological manifestations arise in this context, management requires addressing both the deficiency and the causative exposure.

Clinical scenario: Neurological manifestations of vitamin B12 deficiency where the deficiency is attributable to recreational nitrous oxide use.
Treatment goals

The aim of treatment is to increase vitamin B12 concentrations. Symptoms could start to improve within 2 weeks, but this may take up to 3 months.

Treatment approach

Vitamin B12 replacement is offered, with the route of administration determined by clinical judgement and the person's preference. Stopping recreational nitrous oxide use is a core part of management.

The full structured regimen — including route selection guidance and follow-up — is available via the link below.

Instant Access to Structured Evidence-Based Regimens
References
  • Offer either intramuscular or oral vitamin B12 replacement to people with a vitamin B12 deficiency caused by recreational nitrous oxide use, based on clinical judgement and the person's preference.
  • Advise the person to stop using nitrous oxide recreationally.
  • That their symptoms could start to improve within 2 weeks, but this may take up to 3 months.
  • The aim of treatment is to increase vitamin B12 concentrations.
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