Whipped Cream Charger Abuse: The Toxicologist Mindset

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The Toxicologist Mindset series features real-life cases from the San Francisco Division of the California Poison Control System. Case: A 39-year-old man, with no significant past medical history, was brought to the emergency department by family members, over three consecutive days, for anxiety, confusion, and ataxia. In the first two visits, his laboratory work-up, including complete blood cell count, chemistry panel, liver function tests, urine drug screen, and non-contrast head CT, were unremarkable. On his third visit, he was profoundly encephalopathic with confusion and poor concentration. He had bilateral lower extremity weakness and ataxia. He was admitted to the neurology service for further work up. Additional history revealed that hundreds of empty canisters of whipped cream chargers were found in his house. 1. Why might this patient be abusing whipped cream chargers? Whipped cream chargers, colloquially known as “whippits,” “whippets,” or “hippie crack,” is a steel cartridge filled with nitrous oxide (N2O) gas. In whipped cream cans, dissolved nitrous oxide gas from the cartridges helps the cream transform into a frothy, whipped state upon dispensing. Inhalation of N2O produces a state of analgesia, depersonalization, derealization, dizziness, euphoria, and sound distortion.1 Cartridges are generally easy to obtain, either on the internet, in head shops, or on the street. 2. What is the mechanism of myeloneuropathy by nitrous oxide? Nitrous oxide produces irreversible oxidation of cobalt in vitamin B12, rendering the vitamin B12 molecule functionally inactive. The functional deficiency of vitamin B12 results in an inability to incorporate phospholipids into myelin sheaths, resulting in neuropathy.2 Patients typically present with complaints of numbness, paresthesias, or weakness, and physical exam findings show changes in gait or coordination, difficulty walking, and falls.1 Most case reports describe neurologic sequelae after “chronic” […]