DNP (2,4 dinitrophenol) toxicity

DNP (2,4 dinitrophenol) toxicity

DNP

• is a toxic industrial chemical that is unfit for human consumption and illegal for use in foodstuffs
• causes uncoupling of oxidative phosphorylation (2)
  • DNP decreases the formation of high-energy phosphate bonds in mitochondria and at the same time stimulates systemic oxygen consumption
  • this dissociative effect is known as uncoupling of oxidative phosphorylation
  • DNP interferes with the final energy production pathway for ATP by preventing the uptake of inorganic phosphate molecules into the mitochondria - results in potential energy dissipating as heat, instead of being converted to ATP, with rapid consumption of calories (2)
  • heat production represents a failure in thermoregulatory homeostasis, leading to uncontrolled hyperthermia (2)
• DNP-containing products are still available and may be used by people trying to alter their appearance, such as body builders and those attempting to achieve rapid or extreme weight loss
• by the end of March 2019, there have been 120 separate episodes of systemic DNP exposure discussed with the NPIS since 2007 including 117 discussed since 2012
  • majority involved younger adults, males more often than females
• DNP is usually sold as a yellow powder, sometimes in capsule form, and is marketed as a ''fat burner' or weight loss supplement
  • may be mixed with 'bulking agents,' so the dose of DNP may not be apparent to users which, coupled with the cumulative effect of subsequent doses, can significantly increase the risk to health
  • sold mostly over the internet under a number of different names such as 'DNP', 'Dinosan', 'Dnoc', 'Solfo Black', 'Nitrophen', 'Aldifen' and 'Chemox' (2)
  • DNP, however, is highly toxic, there is no defined 'safe' dose and the chemical should not be consumed under any circumstances.

Clinical features

• clinicall features of DNP poisoning include fever, dehydration, thirst, flushed skin, sweating, dizziness, nausea, vomiting, abdominal pain, agitation, restlessness, confusion, headaches, rapid breathing and a rapid or irregular pulse
  • in severe cases hyperpyrexia, seizures, coma, muscular spasms and death may occur despite optimum medical care
  • toxic effects are more common when higher doses have been consumed
  • consuming lower amounts over longer periods can cause cataracts and skin lesions, and affect the heart, blood and nervous system.

Clinical management:

• any individuals thought to have consumed DNP or considering its use should be advised of the risks
• health professionals dealing with individuals suspected of consuming DNP should advise them to discontinue use immediately and obtain advice on clinical management from the National Poisons Information Service (NPIS) by reference to TOXBASE (www.toxbase.org)
• if features suggesting DNP toxicity
  • referral to hospital immediately for assessment and observation is required; and all symptomatic cases should be discussed with the NPIS by phone (0344 892 0111).

Reference:

• PHE (May 15th 2019) CEM/CMO/2019/002. DNP (2,4 dinitrophenol) toxicity
• Grundlingh J et al. 2,4-dinitrophenol (DNP): a weight loss agent with significant acute toxicity and risk of death.J Med Toxicol. 2011 Sep;7(3):205-12