# Arterial and Venous Thromboembolism Associated With Whippet-Induced Vitamin B12 Deficiency

## TL;DR

A young woman developed both arterial and venous blood clots due to vitamin B12 deficiency from nitrous oxide use, which improved with B12 treatment.

## Contribution

This case report highlights a rare link between whippet use, vitamin B12 deficiency, and dual thromboembolism.

## Key findings

- The patient had both arterial and venous thromboembolism linked to vitamin B12 deficiency.
- Common clotting disorders were ruled out, pointing to B12 deficiency as the primary cause.
- Symptoms improved after vitamin B12 supplementation and medical intervention.

## Abstract

Recreational whippet (nitrous oxide) use is increasing among young adults due to its euphoric effects. However, this practice is associated with vitamin B12 deficiency, which can manifest in a wide range of symptoms. This case report details a case of a 31-year-old female presenting with both arterial and venous thromboembolism secondary to vitamin B12 deficiency induced by whippet use. Initially presenting as a stroke code, initial workup was unremarkable. Later, the patient exhibited right-sided weakness within the first 12 hours and was found to have a perfusion mismatch defect in the left frontal-parietal lobe. Further investigation revealed simultaneously left carotid artery stenosis and occlusion, along with a pulmonary embolism. Treatment included embolectomy and stent placement. Laboratory results confirmed low vitamin B12 levels, elevated methylmalonic acid, and elevated homocysteine. Common causes that were linked with both arterial and venous thromboembolism were ruled out, including lupus, protein C and S deficiency, antithrombin 3 and factor V laden mutation. Following vitamin B12 supplementation and rehabilitation, the patient showed improvement in her aphasia and right-sided weakness.