A 44-year-old South Korean man was rushed to the emergency department of 115 People's Hospital in Ho Chi Minh City in critical condition after overdosing on nitrous oxide (N2O), commonly known as laughing gas. Delayed emergency intervention in such cases can result in permanent neurological damage or even death.

The man was found unconscious in the middle of a city street. He had no identification, was alone, and had multiple bodily injuries along with deep cognitive dysfunction.

Hospital staff immediately coordinated with the 115 Emergency Center and the South Korean Consulate in Vietnam to verify his identity and contact his family.

Dr. Nguyen Phu Quoc, Deputy Head of the Department of Nephrology - Immunology and Transplantation, shared that upon regaining consciousness, the patient exhibited acute neurological symptoms such as disorientation in space and time, agitated shouting, involuntary movements, and behaviors potentially dangerous to himself and others. He also showed signs of acute kidney injury.

A multidisciplinary consultation was held with specialists from various departments. Lab results revealed mild metabolic acidosis and transient renal dysfunction. Tests and imaging ruled out causes like central nervous system infections, metabolic disorders, brain trauma, and stroke. The patient was diagnosed with nitrous oxide poisoning from recreational balloon inhalation.

After 13 days of inpatient treatment including behavioral control, IV fluids, and close monitoring, the patient’s kidney function improved, consciousness gradually returned, and vital signs stabilized.

According to Dr. Quoc, nitrous oxide is a colorless gas with a mildly sweet odor, legally used in dentistry and obstetrics as a mild anesthetic. However, when used recreationally, particularly through high-dose inhalation or in enclosed spaces, it becomes a dangerously hallucinogenic substance.

Mechanistically, nitrous oxide inactivates the enzyme methionine synthase, impeding DNA synthesis and myelin production in both peripheral and central nervous systems. This can lead to neurological symptoms such as tingling, limb weakness, loss of coordination, and memory impairment.

The gas can also induce acute psychosis, respiratory failure, cardiac arrest, arrhythmias, blood cell disorders, and poses serious public health risks.

Phuong Thuy