j.chest.2017.08.411

Critical Care
SESSION TITLE: Poisoning and Drug Overdose 1
SESSION TYPE: Affiliate Case Report Poster
PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM
2,4-Dinitrophenol DNP: A Killer Weight Loss Supplement
Erik Perez* Michael Gale and Olumayowa Abe New York-Presbyterian/Queens, Flushing, NY
INTRODUCTION: 2,4 dinitrophenol (DNP) is a weight loss agent with significant toxicity that may lead to death. It has been
gaining popularity among bodybuilders for rapid weight loss.
CASE PRESENTATION: An 18 year old male presented to our ED with shortness of breathing, palpitations, dizziness, nausea
and bilious vomiting for 1 day in duration. He denied other complaints. He had consumed 1g of DNP daily for 3 days for weight
loss. Upon arrival he became increasingly lethargic, cyanotic, hypotensive and tachycardic. Vital signs: BP: 119/61mmHg, HR:
188/min, RR: 38/min, O2: 98%RA, T: 38.2C. He appeared restless, diaphoretic, tachypneic, flushed and warm. Pupils were 7mm.
Icteric. Dry buccal mucosa. Pulmonary, cardiac and abdominal exam were unremarkable. The skin was erythematous with
yellowish discoloration of the palms and peri-oral area. No needle tracks. Labs were notable for WBC: 28, Lactate: 3.5. Toxicology
screen was negative. Supportive care was provided. Unfortunately, his condition rapidly declined and he developed asystole and
cardiac arrest.
DISCUSSION: 2,4 dinitrophenol (DNP) is an agent reported to cause rapid weight loss, it carries a very high rate of adverse
effects including death. DNP was first used in the early 1900s in the manufacturing industry. Weight loss properties were
discovered in 1933. It was banned by the FDA in 1938. DNP has become increasingly available on the internet by online
pharmacies. There are instructions for self-manufacture. It causes toxicity via uncoupling of oxidative phosphorylation. DNP
interferes with ATP synthase. Energy requiring processes are inhibited. Inorganic phosphate accumulates. Acts as a chemical
ionophore, exports H+ across the mitochondrial membrane. The proton shift gradient is dissipated as heat. Symptoms include
tachycardia, hyperthermia, diaphoresis, tachypnea, jaundice, seizures, cardiovascular collapse. Severe toxicities usually result in
death.
Reference #1: J Grundlingh. J. Med. Toxicol. 2011 7:205-212
Reference #2: Y Lu. J Zhejiang Univ Sci B. 2011
Reference #3: E. Miranda. J Analytical Toxicology, Vol. 30, 2006
DISCLOSURE: The following authors have nothing to disclose: Erik Perez, Michael Gale, Olumayowa Abe
No Product/Research Disclosure Information
DOI:
http://dx.doi.org/10.1016/j.chest.2017.08.411
Copyright ª 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
chestjournal.org
385A
CRITICAL CARE
CONCLUSIONS: DNP is a widely available substance used for weight loss, it frequently causes toxicity and death even at the
proposed recommended doses. Severe toxicities cause death despite treatment. There is no specific antidote. Grater should be
performed to stop it’s online sale. Healthcare providers should be cognizant of the side effects of DNP.