2,4-dinitrophenol (DNP): a weight loss agent with significant acute toxicity and risk of death.

2,4-Dinitrophenol (DNP) is reported to cause rapid loss of weight, but unfortunately is associated with an unacceptably high rate of significant adverse effects. DNP is sold mostly over the internet under a number of different names as a weight loss/slimming aid. It causes uncoupling of oxidative phosphorylation; the classic symptom complex associated with toxicity of phenol-based products such as DNP is a combination of hyperthermia, tachycardia, diaphoresis and tachypnoea, eventually leading to death. Fatalities related to exposure to DNP have been reported since the turn of the twentieth century. To date, there have been 62 published deaths in the medical literature attributed to DNP. In this review, we will describe the pattern and pathophysiology of DNP toxicity and summarise the previous fatalities associated with exposure to DNP.

Pediatric fatality following ingestion of dinitrophenol: postmortem identification of a "dietary supplement".

Dinitrophenol, a chemical currently used as an insecticide, is known to uncouple mitochondrial oxidative phosphorylation. A component of explosives, it has also been used in the past as a food coloring and clothing dye. In the 1930s, physicians prescribed it for weight loss, but this practice was discontinued when reports of cataracts, deaths, and other adverse outcomes came to light. We describe in our report the overdose and fatality of a teenager who purchased the product as a weight loss dietary supplement by mail order. We also describe a laboratory method that allowed postmortem determination of the dinitrophenol concentration in the victim's serum. Her death, despite prompt medical treatment, underscores the danger of dinitrophenol. The easy accessibility and apparent resurgent interest in dinitrophenol as a weight loss agent is extremely timely and troubling.

Dying to be thin: a dinitrophenol related fatality.

2, 4-dinitrophenol (DNP) was originally used as an explosive and later introduced in the 1930's to stimulate metabolism and promote weight loss. It's also a component of pesticides still available globally. Concerns about hyperpyrexia lead to DNP being banned as a dietary aid in 1938. A 22-y-old male presented to the Emergency Department (ED) with a change in mental status 16 h after his last dose of DNP. On admission he was diaphoretic and febrile with an oral temperature of 102 F, but lucid and cooperative. He became agitated and delirious. Intravenous midazolam was initiated with mechanical cooling. Pancuronium was administered later and the patient was intubated. Over the next hour the patient became bradycardic, then asystolic, and despite resuscitative efforts, died. Advertisements claim DNP safe at the dose our patient ingested. It is widely available and with the potential to cause severe toxicity is an understudied public health concern.

[Pentachlorophenol poisoning. Report of 4 cases and review of the literature]. / Intoxicación por pentaclorofenol. Descripción de cuatro casos y revisión de la literatura.

Pentachlorophenol (PCP) was, and still is, one of the most frequently used fungicides and pesticides. The use of PCP has been more restricted during the last few years. PCP's most important industrial application is as a wood preservative. The pentachlorophenol can be absorbed into the body by all the routes of occupational exposure. Some epidemiological observations suggest that exposure to PCP solutions may result in an increased risk for certain diseases in humans, e.g., immunodeficiency, blood disorders, malignancies, congenital anomalies. Chronic poisoning is difficult to detect since symptoms are often vague. Acute poisoning is due to interference with oxidative phosphorylation and can present itself as an unexpected case of sudden death. Four cases of PCP poisoning, including one fatalitie, occurred in two small wood preservative plants. All cases presented with increased serum creatinine phosphokinasa. The clinical finding are reported, and treatment modalities commented. At present there is no antidote for PCP. The basis for treatment is intensive supportive care to maintain vital bodily function. In one patient plasmapheresis was used and rapid recover was obtained. It is suggested that such therapy may be lifesaving in such intoxications.

Mechanisms of toxicity, clinical features, and management of acute chlorophenoxy herbicide poisoning: a review.

INTRODUCTION: Chlorophenoxy herbicides are used widely for the control of broad-leaved weeds. They exhibit a variety of mechanisms of toxicity including dose-dependent cell membrane damage, uncoupling of oxidative phosphorylation, and disruption of acetylcoenzyme A metabolism. Between January 1962 and January 1999, 66 cases of chlorophenoxy herbicide poisoning following ingestion were reported in the literature. FEATURES FOLLOWING INGESTION: Adjuvants in the formulations may have contributed to some of the features observed. Vomiting, abdominal pain, diarrhea, and, occasionally, gastrointestinal hemorrhage were early effects. When present, hypotension was predominantly due to intravascular volume loss, although vasodilation and direct myocardial toxicity may have contributed in some cases. Neurotoxic features included coma, hypertonia, hyperreflexia, ataxia, nystagmus, miosis, hallucinations, convulsions, fasciculation, and paralysis. Hypoventilation occurred not infrequently, usually in association with central nervous system depression, but respiratory muscle weakness was a factor in the development of respiratory failure in some patients. Myopathic symptoms including limb muscle weakness, loss of tendon reflexes, and myotonia were observed and increased creatine kinase activity was noted in some cases. Other clinical features reported included metabolic acidosis, rhabdomyolysis, renal failure, increased aminotransferase activities, pyrexia, and hyperventilation. Twenty-two of 66 patients died. FEATURES FOLLOWING DERMAL AND INHALATIONAL EXPOSURE: Substantial dermal or inhalational 2,4-dichlorophenoxyacetic acid exposure has occasionally led to systemic features but no such reports have been published in the last 20 years and no fatalities have been reported at any time. Substantial dermal exposure has been reported to cause mild gastrointestinal irritation after a latent period followed by progressive mixed sensory-motor peripheral neuropathy. Mild, transient gastrointestinal and peripheral neuromuscular symptoms have also occurred after occupational inhalation exposure, with or without dermal exposure. MANAGEMENT: In addition to supportive care, alkaline diuresis to enhance herbicide elimination should be considered in all seriously poisoned patients. Limited clinical data suggest that hemodialysis produces similar herbicide clearance to alkaline diuresis without the need for urine pH manipulation and the administration of substantial amounts of intravenous fluid in an already compromised patient. CONCLUSIONS: While chlorophenoxy herbicide poisoning is uncommon, ingestion of a chlorophenoxy herbicide can result in serious and sometimes fatal sequelae. In severe cases of poisoning, alkaline diuresis or hemodialysis to increase herbicide elimination should be considered.

Successful treatment of dinitrophenol poisoning in a child.

BACKGROUND: Poisoning with agricultural toxins is well known in the adult environment, but is rarely seen in children. Vancouver, British Columbia, borders on a large agricultural area, and the British Columbia Children's Hospital is the provincial referral center for major pediatric emergencies. In our experience, children from farming communities are vulnerable to a range of agriculturally related injuries, and exposure to toxic chemicals requiring hospitalization is not rare. METHODS: This is a case report with literature review. RESULTS: A child presenting in a coma proved later to have been exposed to a toxic agent. The agent, dinitrophenol, is a widely used agricultural herbicide and insecticide. The diagnosis resulted from a detailed history and physical examination, which revealed symptoms and signs that suggested poisoning. A search of the farm resulted, and the parents located open dinitrophenol containers. The toxic effects of dinitrophenol described in adults by Poison Control matched those present in the child, and specific treatment interventions existed that could be implemented to positively influence outcome. CONCLUSIONS: Awareness of the possibility of exposure to dinitrophenol is required, as death can result from exposure, and milder cases may go unrecognized. Appropriate treatment can improve outcome. Injuries with toxic agricultural agents are wholly preventable if the materials are handled appropriately in the farm environment, and parents whose children live on or visit farms are aware of the risks involved and take appropriate precautions.

Activation of ATP-dependent K+ channels by metabolic poisoning in adult mouse skeletal muscle: role of intracellular Mg(2+) and pH.

1. The effects of metabolic poisoning, intracellular Mg(2+) and pH on ATP-dependent K+ (K+ATP) channels were examined in adult mouse isolated skeletal muscle fibres using the patch clamp technique. 2. In cell-attached membrane patches, while openings of one kind of channel could only rarely be detected under control conditions, cell poisoning with fluorodinitrobenzene (FDNB), dinitrophenol (DNP) and cyanide (CN) induced a strong and partially reversible increase in channel activity. 3. Slope conductance and glibenclamide sensitivity of this outward current indicated that the channel activated during poisoning was the K+ATP channel. 4. Single channel current amplitude was reduced during poisoning, but remained unchanged when activation of the K+ATP channel was induced by cromakalim. 5. In inside-out membrane patches, in the absence of intracellular ATP, intracellular application of Mg2+ decreased channel activity and single channel current amplitude. Inhibition of K+ATP channels by ATP was also reduced. 6. In the absence of intracellular ATP, a decrease in intracellular pH induced a reduction in channel activity and single channel current amplitude. Inhibition of K+ATP channels by ATP was also reduced. 7. The reduction of single channel current amplitude during poisoning was attributed to an increase in intracellular Mg2+ concentration caused by a fall in intracellular ATP concentration. These results also show that metabolic poisoning causes direct activation of K+ATP channels in skeletal muscle, and that is activation is at least partially mediated through an increase in intracellular Mg(2+) concentration and a decrease in intracellular pH.

Intracellular free Ca2+ in the course of the Ca2+ paradox and during poisoning. Ca2+-selective microelectrode measurements in the perfused rat heart.

The free intracellular Ca2+ concentration of perfused rat hearts was measured using Ca2+-selective microelectrodes. In Krebs-Ringer bicarbonate buffer + 0.1 mmol/l Ca2+ (controls) the intracellular Ca2+ concentration was 0.87 +/- 0.07 mumol/l and the membrane potential was -51.5 +/- 0.3 mV. Without glucose the membrane potential approached zero after ca. 60 min, whereas the Ca2+ concentration during 110 min increased only slowly to 10.0 mumol/l. During Ca2+-free perfusion (5 min) both parameters did not change significantly. With reintroduction of 2.0 mmol/l Ca2+ the membrane potential rapidly collapsed and the intracellular Ca2+ concentration was elevated above 0.1 mmol/l within two min. Reperfusion with only 0.1 mmol/l Ca2+ decelerated both changes. Poisoning by carbonyl cyanide-p-trifluoromethoxyphenylhydrazone or antimycin A in Ca2+-free Krebs-Ringer bicarbonate buffer increased the intracellular Ca2+ concentration to 30.0 and 25.0 mumol/l, and the membrane potential was collapsed after 16 and 10 min, respectively. In antimycin A- and Ca2+-containing sucrose medium the intracellular Ca2+ during 16 min increased above 1.0 mmol/l, and the membrane potential began to increase only after 10 min. The results are consistent with the postulate of a hypothetical mechanism of cell injury, in which noxious membrane-cytoskeleton interactions are induced by an elevated intracellular Ca2+ concentration. It is concluded that Ca2+ entry via Na/Ca exchange is not fundamentally involved with induction of injury.