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July 1984

Subacute Toxic Delirium Caused by Nitrous Oxide May Be an Acute Withdrawal State

Author Affiliations

8 Highlands House (NBS Center) 173 Lewis Botha Ave Orange Grove 2192, South Africa

Arch Neurol. 1984;41(7):704. doi:10.1001/archneur.1984.04050180026006

To the Editor.  —The case of subacute toxic delirium following nitrous oxide (N2O) abuse1 is the second well-documented case in the literature.2 In both cases, some of the symptoms appeared to be identical to those found in other well-known opioid and alcohol withdrawal states. It does not appear to be well known that N2O is an opioid agonist. This has been demonstrated both in vitro3,4 and in vivo.5-8 In addition, a close link between an opioid withdrawal state and N2O was clearly demonstrated by Kripke and Hechtman,9 who showed that a patient with a pentazocine addiction could be successfully weaned with analgesic concentrations of N2O. Furthermore, we have shown that N2O can ameliorate the alcohol withdrawal state,10 and this cross-tolerance has been demonstrated experimentally as well.11We therefore consider that this interesting case

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