II. Definitions
- Dinitrophenol (DNP)
- Organic substances, phenols with 2 attached nitro groups
III. Background
- DNP has been used to produce explosives (e.g. Shellite, Tridite), and in production of black dye
- Fatal, accidental Poisonings have occurred in manufacturing workers
- 2,4 DNP has been used in humans
- This article refers specifically to 2,4 DNP toxicity (adverse effects, labs, management)
- Used by the Russian Red Army in World War 2 to promote cold hardiness
- Blocks lipogenesis, and was used as a weight loss agent in U.S. until it was banned by the FDA in 1938
- Has been on and off the 1972 Poisons List (pending possible reinsertion into that list as of 2021)
- Illicit use by body builders continues (obtained online)
IV. Mechanism
- Uncouples Oxidative Phosphorylation, blocking ATP formation
- Increases intracellular Calcium, resulting in increased Muscle Contraction and heat generation
V. Pharmacokinetics
- Rapidly absorbed from intestinal tract (as well as inhaled or absorbed through skin)
- Toxic dose: 1-3 mg/kg
- Half-Life: Days
- Hepatic metabolism
VI. Adverse Effects
- Acute Hypermetabolic State (may be lethal)
- Hyperthermia, Tachycardia, Tachypnea, Diaphoresis
- Muscle spasms to Rhabdomyolysis
- Acute Renal Failure
- Metabolic Acidosis
- Altered Mental Status, Agitation, Seizures
- Longterm effects
- Cataract rapid development
VII. Labs
- See Unknown Ingestion for complete toxicology workup
- Comprehensive Metabolic Panel
- Creatine Phosphokinase (CPK)
VIII. Management
- Detoxification
- Activated Charcoal if presentation within one hour of large ingestion
- Intravenous Fluids
- Agitation or Seizures
- Hyperthermia
- External cooling
- Dantrolene
- Disposition
- May medically clear if asymptomatic at 10-12 hours after ingestion
- Observe all symptomatic ingestions, especially with hypermetabolic symptoms (e.g. Tachycardia, hyperthermia)
IX. Resources
- 2,4-Dinitrophenol (Wikipedia)
X. References
- Tomaszewski (2022) Crit Dec Emerg Med 36(10): 32