Recreational Nitrous Oxide Use: A Growing Trend with Unintended Consequences

Abstract

Aims
To describe the incidence, demographic profile, and clinical characteristics of hospital admissions related to nitrous oxide (NO) misuse in the Republic of Ireland, and to compare these findings with international trends.

Methods
A retrospective observational study was conducted using the National Quality Assurance and Improvement System (NQAIS) Clinical tool. All inpatient discharges between 2020 and 2024 coded for NO misuse or toxicity (ICD-10: T41.0) were included. Demographics, length of stay, specialty involvement, and readmission rates were analysed.

Results
Sixty-three discharges were identified over four years, representing a more than four-fold increase in quarterly admissions when comparing Q1 2020 with Q4 2023. The mean age was 19.7 years (SD 2.4), with 87.3% (n = 55) from the Dublin area. Males accounted for 68.2 % (n = 43). The mean hospital stay was 7.9 days, and 82% (n = 52) had confirmed vitamin B12 deficiency. Neurology and general medicine managed all cases, with frequent allied-health input: physiotherapy (76 %), occupational therapy (64 %), and social work (48 %).

Discussion
Hospitalisations related to NO misuse have risen sharply, affecting predominantly young adults and placing increased demand on inpatient services. Findings align with European data, highlighting the need for youth-targeted prevention, awareness campaigns, and multidisciplinary follow-up pathways.