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RISK CHARACTERIZATION
For this review, qualitative risk estimates were made
based on the frequency and types of LN2 injuries reported
in the literature from related case reports. These risks are
characterized below.
Risk of thermal injury
In terms of direct skin or tissue contact with LN2, cold
burns to the hands or mouth tend to be a commonly
encountered injury. The likelihood of cold burns developing
is high if direct contact for more than a very brief period of
time is made with LN2 itself, the chilled treats, or the serving
cups holding LN2. The severity of the injury depends on the
duration and extent of contact, and the most serious cases
may require amputation. However, the likelihood of this
occurring is very low because only a few cases have been
reported in the literature (9, 14, 31).
Risk of inhalation injury
Generally, when LN2 is inhaled during consumption,
health effects are not likely to occur if exposure is minimal
and spaces are well ventilated. However, patrons with asthma
or other underlying respiratory conditions may be at risk of
experiencing an exacerbation of disease following inhalation
of LN2.
Risk of ingestion injury
Consumers are less likely to be injured if the LN2 has
completely evaporated before they consume the food or
beverage containing LN2 (e.g., ingestion injuries such as
gastric perforation would not occur). However, individuals
may still experience discomfort or thermal burns due to
the cold temperature of the food or beverage (32). On the
other hand, if LN2 itself is ingested prior to its evaporation,
there is a risk of developing gastrointestinal barotrauma and
perforations. In fact, 10 of the 17 cases reported this as the
primary injury experienced after ingestion of LN2 prior to
its evaporation. However, due to potential publication and
reporting bias, perforations are more likely to be reported
than other types of ingestion injuries. Therefore, these
findings should be interpreted carefully.
DISCUSSION
There are many potential injuries that consumers may
face when consuming foods and beverages containing LN2.
Among all the ones discussed, inhalation and ingestion
injuries tend to be the most severe because they often result
in hospitalization or require surgery. Barotrauma with gastric
perforation is the most severe outcome identified. Thermal
injuries may also occur; however, their health impact tends to
be minor because these injuries usually heal after a few days
and do not always require hospitalization. Unfortunately, due
to the lack of dietary exposure data available on LN2-infused
foods and beverages, it is unknown which age groups are

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exposed to LN2 the most. Whereas exposure among certain
groups will vary depending on the food or beverage being
served (e.g., alcoholic or nonalcoholic), children and young
adults may be more likely to try treats that are prepared with
LN2 (11, 14, 21, 30, 42). Based on the case reports reviewed,
this age range could be anywhere from 12 to 30 years.
However, note that 4 of the 17 case reports reviewed did not
mention age, which could lead to an underestimation of risk
for the age groups not accounted for. Therefore, this range
should be interpreted with caution.
It also appears from the case reports that adverse outcomes
related to LN2 in food may be more frequent in males than
females (2, 30, 41, 43). For example, of the 17 cases found
in this review, 11 were male and 6 were female. In addition,
the most serious outcomes, gastric perforation injuries,
were reported in 8 male and 2 female cases. Though the
counts are small, it is possible that the higher number of
adverse outcomes in males are related to biopsychosocial or
environmental factors such as risk-taking behavior and/or
peer pressure.
Fortunately, jurisdictions are starting to realize the hazards
of LN2 consumption. For example, although the United
States does not prohibit the use of LN2 in foods, the U.S.
Food and Drug Administration did issue a warning in 2018,
advising consumers to avoid such treats (37). Moreover, in
Canada, Work Safe British Columbia categorized exposure
to LN2 during food preparation as an " emerging risk " to food
handlers in 2017 (3). To mitigate such risks, the Ontario
Ministry of Labour, Canadian Centre for Occupational
Health and Safety, and Work Safe British Columbia
published risk advisories and guidelines for how to safely
handle the agent in the workplace (4, 28, 40). In the United
Kingdom, a bar was fined after a patron's stomach ruptured
and had to be removed following ingestion of a LN2-infused
cocktail (5, 30). Despite the risks, LN2-infused foods and
drinks continue to be served around the world. What is more
concerning is that there are now online articles and videos
explaining to inexperienced viewers how to make these
treats at home (3, 30). Thus, to help reduce the risk of injury
following consumption of these foods, a list of risk mitigation
measures has been provided below for regulatory agencies,
vendors, and consumers to consider.
Risk mitigation measures for regulatory agencies
Although such cases are rare, public health authorities
should monitor for cases of injury in relation to LN2
consumption (30). In addition, they should reevaluate its
safety whenever new scientific evidence is available (30).
To ensure the public is safe from harm, alerts and advisories
should be issued when necessary to inform consumers about
any potential risks (30). Furthermore, regulators should
consider enacting stricter policies with regard to adding
LN2 directly to foods and drinks at points of purchase.
For example, rather than mixing food and LN2 together in
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