“Whippets”-induced vitamin B12 deficiency and dorsal column degeneration

Abstract

A 32 year old pregnant woman at 11th week gestation
presented with 2 weeks of progressive gait difficulty and
ascending weakness. Patient admitted to recreational
inhalation of nitrous oxide from whipped-cream bulbs
“whippets”. On examination, she had mild weakness in
her extremities. Laboratory examination was significant
for a low serum cobalamin (vitamin B12) level. Furthermore, homocysteine and methylmalonic acid were elevated. Parietal cell and intrinsic factor antibodies were
negative. She was started on vitamin B12 injections and
transferred to an acute rehabilitation facility.