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

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Abstract

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.

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Authors and Affiliations

  1. Department of Emergency Medicine, Division of Medical Toxicology, Carolinas Healthcare System, 1000 Blythe Blvd, MEB 3rd floor, Charlotte, NC, 28203, USA

    Kathryn T Kopec

  2. Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA

    Caroline Freiermuth

  3. Carolinas Pathology Group, Carolinas Healthcare System, Charlotte, NC, USA

    Susan Maynard

  4. Department of Emergency Medicine, Carolinas Poison Center, Charlotte, NC, USA

    Michael Beuhler

Authors
  1. Kathryn T Kopec
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  2. Caroline Freiermuth
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  3. Susan Maynard
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  4. Michael Beuhler
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Corresponding author

Correspondence to Kathryn T Kopec.

Ethics declarations

Consent was not available, but this case was anonymized according to JMT guidelines and publication was approved after review by members of the editorial board because the manuscript primarily focuses on the laboratory issues identified by this clinical event.

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Kopec, K.T., Freiermuth, C., Maynard, S. et al. Dinitrophenol (DNP) Fatality Associated with a Falsely Elevated Salicylate Level: a Case Report with Verification of Laboratory Cross Reactivity. J. Med. Toxicol. 14, 323–326 (2018). https://doi.org/10.1007/s13181-018-0677-1

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  • DOI: https://doi.org/10.1007/s13181-018-0677-1

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