Letter To The Editor: “Comment on “Pediatric Fatality Following Ingestion of Dinitrophenol: Postmortem Identification of a ‘Dietary Supplement’””

Barker, Kim; Seger, Donna; Kumar, Suparna

doi:10.1080/15563650600584709

Cited by 3 publications

(2 citation statements)

References 4 publications

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“…Barker et al (2005) state that ‘DNP uncouples oxidative phosphorylation, causes release of calcium from mitochondrial stores and prevents calcium re-uptake’. 14 They cite a 1988 study by Elz and Nayler 15. They then go on to conclude that this ‘ leads to free intracellular calcium, causing muscle contraction and hyperthermia’ (unreferenced).…”

Section: Discussionmentioning

confidence: 99%

Dantrolene is not the answer to 2,4-dinitrophenol poisoning: more heated debate

Schoor¹,

Khanderia

Thorniley

2018

BMJ Case Rep

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There has been a resurgence in the use of 2,4-dinitrophenol, C6H4N2O5 (DNP) recently as an illegal weight loss drug. We present a case of a healthy 25-year-old girl who took two tablets of DNP, purchased from an overseas online retailer. She was managed with aggressive, invasive cooling measures and 2.5 mg kg–1 dantrolene. Despite this, her temperature continued to rise exponentially to 41.5°C. Cardiac arrest occurred and resuscitation was unsuccessful. To our knowledge, this is the first reported case of the ineffective use of dantrolene in acute DNP poisoning. We review the pathophysiology of DNP toxicity and argue that the use of dantrolene therapy is biochemically implausible, based on poor evidence and likely to be futile. We have contacted the UK National Poisons Information Service (NPIS/TOXBASE) to propose changes to the management of acute DNP toxicity.

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Section: Discussionmentioning

confidence: 99%

Dantrolene is not the answer to 2,4-dinitrophenol poisoning: more heated debate

Schoor¹,

Khanderia

Thorniley

2018

BMJ Case Rep

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“…This has contributed to an increasing number of mortalities caused by 2,4-DNP ( 5 , 37 , 39 , 44 – 46 ). It is also important to note that although isolated cases of treatments for 2,4-DNP overdoses have been reported with varying degrees of effectiveness [see ( 47 )], there is to date no established cure or treatment for a 2,4-DNP overdose.…”

Section: Introductionmentioning

confidence: 99%

Would You Use It With a Seal of Approval? Important Attributes of 2,4-Dinitrophenol (2,4-DNP) as a Hypothetical Pharmaceutical Product

2018

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Background2,4-Dinitrophenol (2,4-DNP) is an effective but highly dangerous fat burner, not licensed for human consumption. Death cases reported for 2,4-DNP overdose, particularly among young adults, have raised concerns about the ineffective regulatory control, lack of education and risks associated with impurity, and the unknown concentration of 2,4-DNP purchased on the Internet.MethodsUsing a sequential mixed method design and based on a hypothetical scenario as if 2,4-DNP was a licensed pharmaceutical drug, first we conducted a qualitative study to explore what product attributes people consider when buying a weight-loss aid. Focus group interviews with six females and three males (mean age = 21.6 ± 1.8 years) were audiorecorded, transcribed verbatim, and subjected to thematic analysis. Sixteen attributes were identified for the Best–Worst Scale (BWS) in the quantitative survey with 106 participants (64% female, mean age = 27.1 ± 11.9 years), focusing on 2,4-DNP. Demographics, weight satisfaction, and risk for eating disorder data were collected.ResultsIn contrast to experienced users such as bodybuilders, our study participants approached 2,4-DNP cautiously. Attributes of 2,4-DNP as a hypothetical weight-loss drug comprised a range of desirable and avoidable features. Of the 16 selected attributes, BWS suggested that long-term side effects were the most and branding was the least important attribute. Effectiveness and short-term side effects were also essential. Those in the >25 year group showed least concerns for legality. Neutral BWS scores for cost, treatment, degree of lifestyle changes required, and specificity required for the hypothetical weight-loss drug to be effective were likely caused by disagreement about their importance among the participants, not indifference.ConclusionWith advances in research, 2,4-DNP as a pharmaceutical drug in the future for treating neurodegenerative diseases and potentially for weight loss is not inconceivable. Caution is warranted for interpreting the BWS scores. Owing to the difference in what data represent at individual vs. population levels, with pooled data, the method correctly identifies attributes by which most people are satisfied but misrepresents attributes that are individually very important but not universally agreed. Whilst this may be an advantage in marketing applications, it limits the utility of BWS as a research tool.

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