Case of 2,4-Dinitrophenol Intoxication: A Lethal Weight-Loss Alternative Returns

Introduction: Initially used as a weight loss suplemment, 2,4 Dinitrophenol (DNP) was banned due to its toxicity. However, its use resurfaced among bodybuilding and dieting groups as a weight loss alternative pushed by online blogs and marketplaces seemingly circumventing heavy regulation. Case Description: A 43-year-old man with history of depression and previous suicide attempts was transferred to our institution following ingestion of a weight loss supplement. He was brought by police officers who responded to a welfare check by his ex-wife. They stated the patient earlier expressed desire to commit suicide with ingestion of 10 instead of his usual daily 3 drops of DNP. He was started on cooling measures due to hyperpyrexia (41C), dantrolene was administered, then airlifted to our institution. Laboratories showed acute kidney injury, worsening lactic acidosis, and elevated creatinine kinase, with refractory hyperkalemia. Clinical deterioration ensued, with worsening diaphoresis, tachycardia, tachypnea, yellowing of distal extremities, and hypotension requiring escalating vasopressor support, mechanical ventilation and dialysis. Complications included rhabdomyolisis with bilateral lower extremity compartment syndrome requiring bedside fasciotomies and lastly, DIC. Unable to sustain adequate perfursion despite four vasopressors, the patient expired 30 hours after ingestion. Discussion: Identified in both accidental and intentional intoxications, once ingested DNP is a potent decoupler of oxidative phosphorylation at the mitochondria, shifting to anaerobic respiration. Pyrexia and rhabdomyolysis are common complications along with characteristic discoloration of skin culminating in multiorgan failure. No known antidote is available at this time, and mortality remains high with scarce data to guide treatment. Therefore, it is crucial to raise awareness as preventing ingestion is likely the best available strategy to save lives.Figure 1