Homemade Nitrous Oxide: No Laughing Matter

NITROUS OXIDE, a common anesthetic gas, is produced by the combustion of ammonium nitrate (NH4NO3). Extensive commercial purification removes toxic by-products such as ammonia and oxides of nitrogen, princi-pally nitric oxide (NO) and nitrogen dioxide ( N 0 2). Rarely does the purification fail (1). We report a patient who had acute pulmonary toxicity after inhaling home-made nitrous oxide containing high levels of nitrogen di-oxide. To our knowledge, a similar case has not been reported. A 20-year-old white man with a 3-day history of dyspnea, chills, pleuritic chest pain, wheezing, and coughing mucoid spu-tum came to the emergency room of Shands Teaching Hospital. The symptoms had begun suddenly after the inhalation of homemade nitrous oxide produced from ammonium nitrate fer