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
Gillman MA, Lichtigfeld FJ, Sandyk R. Subacute Toxic Delirium Caused by Nitrous Oxide May Be an Acute Withdrawal State. Arch Neurol. 1984;41(7):704. doi:10.1001/archneur.1984.04050180026006
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