Survival of Acute-on-Chronic 2,4-Dinitrophenol Overdose with Associated Pharmacokinetics.

INTRODUCTION: 2,4-dinitrophenol (DNP) is an uncoupler of oxidative phosphorylation and is highly toxic in overdose. CASE REPORT: We present a case of an 18-year-old female who survived an acute-on-chronic DNP overdose resulting in hypermetabolic state and widespread ST depression with associated troponin I elevation. Serial DNP levels are plotted for this patient, demonstrating first order kinetics with a half-life of 18 h. DISCUSSION: Survival in this case may be attributed to early management of hyperthermia and hypermetabolic state, as well as the acute-on-chronic nature of the overdose. Human pharmacokinetic data for DNP in overdose are rare, as are cases with ST-segment changes.