Fatal poisoning with 2,4-Dinitrophenol: learning via case study

After completing this module, the paramedic will be able to:

A26-year-old man presented to the authors' emergency department (ED) in Lancashire at 05:15, having taken a deliberate overdose of 2,4-dinitrophenol (DNP). The patient's medical history was significant for asthma, anxiety, depression and deliberate self-harm. There was also a history of three previous overdoses (of paracetamol and zopiclone), suicidal ideation, severe acne, body dysmorphia and anabolic steroid use. He was known to mental health services.

Collateral history suggested the patient had been taking DNP orally as a bodybuilding supplement. His drug history was significant for allergies to erythromycin and tetracyline (rash) as well as citalopram intolerance (worsening anxiety and insomnia). Repeat prescriptions included diprobase and fluoxetine, though compliance was reportedly poor. The patient's social history included employment as a chef, living with his mother, being an ex-smoker of 5 pack-years and a significant alcohol intake of >160 units/week periodically.

The patient presented to his mother in an agitated state at 04:20, admitting to having deliberately ingested DNP (quantity unknown) at approximately 01:00 in an attempt to end his life. Emergency medical services (EMS) were called for at 04:29, dispatched at 04:31 and were with the patient by 04:51. Time on scene was short given his physical appearance and agitation; EMS observations were notable for a respiratory rate of 44, saturations of 98% on room air, normotension with a capillary refill time <2 seconds, tachycardia at 172 bpm and normothermia. The patient was alert but agitated. The EMS left the scene at 04:58 and arrived at the ED at 05:09, where the patient was admitted directly to a resuscitation bay. The attending EMS personnel had been unable to gain intravenous access or obtain an ECG because of the patient's agitated state.