Dinitrophenol toxicity: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
''High clinical suspicion needed" | |||
*Blood glucose | |||
*CBC | |||
*Chemistry | |||
*Arterial blood gas or Venous blood gas | |||
**Co-oximetry to evaluate for [[methemoglobinemia]] | |||
*[[Lactate]] | |||
*Coagulation studies | |||
*Creatine phosphokinase | |||
*Urine analysis | |||
*[[ECG]] | |||
*Chest x-ray | |||
*CT brain and/or[[LP]] as needed | |||
==Management== | ==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<ref>Kumar S, Barker K, Seger D. Dinitrophenol-induced hyperthermia resolving with dantrolene administration. Clin Toxicol. 2002;40:599-673.</ref> | |||
*Avoid salicylates | |||
==Disposition== | ==Disposition== | ||
*Admission for most patients | |||
*Observation if stable | |||
==See Also== | ==See Also== | ||
*[[Hyperthermia]] | |||
==External Links== | ==External Links== |
Revision as of 22:12, 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
Diagnosis
High clinical suspicion needed"
- Blood glucose
- CBC
- Chemistry
- Arterial blood gas or Venous blood gas
- Co-oximetry to evaluate for methemoglobinemia
- 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
- 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
- ↑ 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.
- ↑ Kumar S, Barker K, Seger D. Dinitrophenol-induced hyperthermia resolving with dantrolene administration. Clin Toxicol. 2002;40:599-673.