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dok_zlo — 05.07.2025

Frostbite Injury from Inhaled Nitrous Oxide Use

A 23-year-old man presented to an outpatient health center with a 2-day history of painful swallowing and hoarseness. The symptoms had started immediately after he had inhaled nitrous oxide through his mouth from a hand-held canister for recreation. Physical examination was notable for erythema, swelling, and sloughing of the mucosa on the soft palate, uvula, and posterior oropharynx (Panel A). There was no increased work of breathing or stridor. A referral to an otorhinolaryngologist was made. Flexible nasolaryngoscopy revealed a small area of ulceration and swelling on the right vocal fold (Panel B). A diagnosis of frostbite injury from inhaled nitrous oxide use was made. Nitrous oxide gas, which is known as “whippets” or “laughing gas” when inhaled recreationally, is stored as a liquid in pressurized canisters. Both the gas and the canister rapidly become cold on release of the gas and may result in contact frostbite injuries. Treatment with over-the-counter analgesics, viscous lidocaine, and topical triamcinolone paste was given. The patient was lost to follow-up.
Michael Patrizio, M.D. , and Meredith Hayden, M.D.
Published July 2, 2025
N Engl J Med 2025;393: e1
DOI: 10.1056/NEJMicm2502232
VOL. 393 NO. 1

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