Dinitrophenol toxicity: Difference between revisions

(DNP)
(DNP)
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==Differential Diagnosis==
==Differential Diagnosis==
*[[jaundice]]
*[[jaundice]]
*{{Acute fever DDX}}
*{{Acute Fever DDX}}


==Diagnosis==
==Diagnosis==

Revision as of 22:13, 27 October 2015

Background

  • Used in the manufacture of munitions, as a dye, a wood preserver, herbicide and photograph developer
    • Can lead to unintentional exposures
  • Discovered as a weight loss drug in 1930's but banned by FDA soon afterwards due to side effects
  • Now banned in US and UK as weight loss drug, labeled "not fit for human consumption"
  • Able to purchase DNP online in mass quantities[1]
    • Typically used by body builders for weight loss
    • Suicidal intentional ingestion
    • Increase in number of deaths in recent years

Pharmacology

  • Uncouples oxidative phosphorylation
    • Allows increase in basal leak of protons (H+) accross the mitochondrial membrane which is dissipated as heat and leads to hyperthermia
  • Stimulation of glycolysis in small doses

Clinical Features

Very narrow therapeutic window

"Theraputic dose"
  • Pruritic rash
  • Yellow discoloration of skin, eyes, and urine (appears similar to jaundice)
  • Peripheral neuropathy
  • anorexia
  • confusion
  • cataracts
  • deafness
  • coma
acute toxicity
  • profuse diaphoresis
  • hyperthermia
  • tachypnia
  • tachycardia
  • convulsions
  • shock/cardiovascular collapse
  • PEA/death

Differential Diagnosis

Infectious

Non-infectious

Diagnosis

High clinical suspicion needed"

  • Blood glucose
  • CBC
  • Chemistry
  • Arterial blood gas or Venous blood gas
  • Lactate
  • Coagulation studies
  • Creatine phosphokinase
  • Urine analysis
  • ECG
  • Chest x-ray
  • CT brain and/orLP as needed

Management

  • Decontamination with removal of clothing and irrigation as needed
  • Constant body temperature monitoring, cardiac monitor, IV access, and code cart to bedside
  • Activated charcoal if within 1 hour of ingestion
    • No evidence for or against multiple doses of charcoal or whole bowel irrigation
  • Aggressive IVF administration (cooled if possible)
  • Vasopressors with cardiovascular collapse non-responsive to IVF
  • Treat methemoglobinemia as needed
hyperthermia
  • External cooling with blankets, ice, and cooling devices
  • Cool IVF
  • Control agitation (adds to hyperthermia)
    • benzodiazepines
    • Paralyze and intubate if not controlled with benzos
  • Dantrolene has been used to manage DNP hyperthermia[2]
  • Avoid salicylates

Disposition

  • Admission for most patients
  • Observation if stable

See Also

External Links

References

  1. Grundlingh, Johann, Paul I. Dargan, Marwa El-Zanfaly, and David M. Wood. "2,4-Dinitrophenol (DNP): A Weight Loss Agent with Significant Acute Toxicity and Risk of Death." Journal of Medical Toxicology J. Med. Toxicol. 7.3 (2011): 205-12. Web.
  2. Kumar S, Barker K, Seger D. Dinitrophenol-induced hyperthermia resolving with dantrolene administration. Clin Toxicol. 2002;40:599-673.