'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.
Siegmueller
Claas
C
St George's Healthcare NHS Trust, Anaesthetic Department, Blackshaw Road, London, UK. claas.siegmueller@yahoo.co.uk
Narasimhaiah
Raghunanda
R
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