Case report
Nitrous oxide-induced vitamin B12 deficiency

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Abstract

Two patients with asymptomatic vitamin B12 deficiency developed a peripheral neuropathy 6–7 weeks after exposure to nitrous oxide during general anaesthesia, and 3 and 11 days after receiving cyclophosphamide. The serum B12 concentration was less than 20 pmol/l and the symptoms resolved after B12 replacement. We believe that the neurological symptoms were triggered by exposure to nitrous oxide. A possible novel feature in these patients was the close temporal relationship between the onset of the symptoms and cyclophosphamide treatment. It is possible that cyclophosphamide reduced the availability of remaining B12 stores.

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