Nitrous oxide use has increased sharply in the 2020s. The scientific evidence has tightened accordingly.
Acute risks:
- Syncope (brief loss of consciousness) from oxygen displacement
- Falls when using while standing or poorly secured (stairs, pool, sharp furniture)
- Frostbite from direct use out of capsules without a balloon (nitrous oxide is released at −89 °C)
- Suffocation in enclosed spaces or with mask setups
Chronic risks:
- Vitamin B12 inactivation through cobalt oxidation — vitamin B12 is rendered ineffective, even when levels appear normal
- Funicular myelosis — neurological damage to the spinal cord: numbness, unsteady gait, paralysis
- Cognitive deficits — concentration problems, depressive episodes
- Partly irreversible with prolonged use without treatment
Practical risk reduction:
- Sit or lie down, never stand or use in water
- Small balloon amounts (max. 1 cream charger per inhalation)
- Enough breaks with normal air between inhalations
- For regular use: check B12 levels, supplement B12 prophylactically (methylcobalamin or hydroxocobalamin)
- For numbness, unsteady gait or concentration problems: get medical evaluation