'Fatal 2,4-dinitrophenol poisoning... coming to a hospital near you'.
An adult man was brought into the emergency department after deliberate ingestion of dinitrophenol: an agent that uncouples mitochondrial oxidative phosphorylation. The patient rapidly developed a hyper-metabolic state with fever, respiratory failure and died within a few hours after admission. Dinitrophenol is used in the manufacture of dyes, pesticides and explosives. Sub-acute poisoning is associated with weight-loss and the substance had been prescribed for this purpose during the 1930s in the United States before being banned due to serious side effects. Although remaining unlicensed as a drug, dinitrophenol is widely available through mail-order websites and online pharmacies, which promote it as an anti-obesity treatment. This case highlights the need for awareness of possibly increasing rates of accidental poisoning with a growing obesity prevalence and availability of this unlicensed drug through the internet. Additionally, we discuss the use of dantrolene in dinitrophenol poisoning and question whether current Toxbase/UK National Poison Information Service treatment guidelines regarding the indication and dosing of this drug, the only relatively specific treatment in dinitrophenol poisoning presently recommended, could be revised.
St George's Healthcare NHS Trust, Anaesthetic Department, Blackshaw Road, London, UK. claas.siegmueller@yahoo.co.uk
Claas
C
Siegmueller
Raghunanda
R
Narasimhaiah
D019297:2,4-Dinitrophenol / Q000506:poisoning*; D000328:Adult; D002125:Calcium Gluconate / Q000627:therapeutic use; D003620:Dantrolene / Q000627:therapeutic use*; D004638:Emergency Treatment / Q000379:methods*; D017809:Fatal Outcome; D006801:Humans; D006947:Hyperkalemia / Q000188:drug therapy / Q000209:etiology; D007262:Infusions, Intravenous; D008297:Male; D009125:Muscle Relaxants, Central / Q000627:therapeutic use*; D011041:Poisoning / Q000150:complications / Q000188:drug therapy
D009125:Muscle Relaxants, Central; D003620:Dantrolene; D019297:2,4-Dinitrophenol; D002125:Calcium Gluconate