Dinitrophenol (DNP) Fatality Associated with a Falsely Elevated Salicylate Level: a Case Report with Verification of Laboratory Cross Reactivity

Introduction 2,4-Dinitrophenol (DNP) is a known uncoupler of oxidative phosphorylation that clinically leads to hyperthermia, tachycardia, tachypnea, and metabolic acidosis. Intentional overdoses of DNP are often fatal. We present an analytically confirmed fatal case of DNP overdose with a falsely p...

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Bibliographic Details
Published in:Journal of medical toxicology 2018-12, Vol.14 (4), p.323-326
Main Authors: Kopec, Kathryn T, Freiermuth, Caroline, Maynard, Susan, Beuhler, Michael
Format: Article
Language:English
Subjects:
2,4-Dinitrophenol
Acidosis
Assaying
Bioassays
Biomedical and Life Sciences
Biomedicine
Case Report
Case reports
Colorimetry
Drug overdose
Hyperthermia
Metabolic acidosis
NAD
NADH
Nicotinamide adenine dinucleotide
Overdose
Oxidative phosphorylation
Pharmacology/Toxicology
Phosphorylation
Salicylic acid
Tachycardia
Tachypnea
Toxicity
Toxicology
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Summary:Introduction 2,4-Dinitrophenol (DNP) is a known uncoupler of oxidative phosphorylation that clinically leads to hyperthermia, tachycardia, tachypnea, and metabolic acidosis. Intentional overdoses of DNP are often fatal. We present an analytically confirmed fatal case of DNP overdose with a falsely positive elevated salicylate concentration. We further explored this cross reactivity of DNP with two salicylate assays. Methods Clinically relevant serial dilutions of DNP were prepared in drug-free serum and analyzed using two different colorimetric NADH/NAD-based analytical methodologies. Results The enzymatic salicylate assay demonstrated a reproducible false elevation of salicylate starting at a DNP level of 100 mg/L while the EMIT-based methodology was without any such interference at the maximum concentration tested (150 mg/L). Conclusions DNP cross reacts with some salicylate assays. This knowledge is important for providers, as there are significant variations in the management of DNP versus salicylate toxicity.
ISSN:1556-9039
1937-6995
DOI:10.1007/s13181-018-0677-1