Similar articles

Abstract: Objective: The intoxications caused by 2,4-Dinitrophenol (2,4-DNP), even death, have been frequently reported in recent years. This study aims to investigate the dynamic changes of plasma toxin concentration and explore the clinical value of resin hemoperfusion (HP) in the treatment of patients with acute 2,4-DNP poisoning. Methods: We reported 16 cases of acute 2,4-DNP poisoning through occupational exposure due to ignoring the risk of poisoning. The blood samples were collected from the 14 survivors. According to the different treatments of resin HP, the survivors were divided into routine HP (n=5) and intensive HP (n=9) groups. Ultra high performance liquid chromatography/ tandem mass spectroscopy (UPLC-MS/MS) was used to detect the 2,4-DNP concentration in plasma in this study. Results: The 14 survivors recovered very well after treatment. The initial plasma 2,4-DNP concentrations (C₁) of survivors ranged from 0.25 to 41.88 µg/ml (mean (12.56±13.93) µg/ml). A positive correlation existed between initial plasma 2,4-DNP concentration (C₁) and temperature. The elimination of 2,4-DNP was slow and persistent, and the total clearance rates of plasma toxin from the 1st to 3rd day (R₃), the 3rd to 7th day (R_3&#x2013;7), and the 1st to 7th day (R₇), were only (53.03±14.04)%, (55.25±10.50)%, and (78.29±10.22)%, respectively. The plasma toxin was cleared up to 25 d after poisoning in most of the patients. The R₃, R_3&#x2013;7, and R₇ in the intensive HP group were all apparently higher than those in the routine HP group, with statistical significance (P<0.05). Simultaneously, the elimination half-life (t_1/2) of 2,4-DNP in the intensive HP group was apparently shorter than that in the routine HP group, with statistical significance (P<0.05). Conclusions: The clinicians should be aware of this slow and persistent process in the elimination of plasma 2,4-DNP. Higher initial plasma toxin concentration resulted in a more severe fever for the patient. According to the limited data, longer and more frequent resin HP may accelerate to eliminate the poison.

血液灌流对急性2,4-二硝基苯酚中毒患者的毒物清除疗效评估

[1]Brandenburg, R., Brinkman, S., de Keizer, N.F., et al., 2014. In-hospital mortality and long-term survival of patients with acute intoxication admitted to the ICU. Crit. Care Med., 42(6):1471-1479.

[2]Colman, E., 2007. Dinitrophenol and obesity: an early twentieth-century regulatory dilemma. Regul. Toxicol. Pharmacol., 48(2):115-117.

[3]Daudu, P.A., Rozanov, C., Roy, A., et al., 2002. Effects of 2,4-dinitrophenol (DNP) on the relationship between the chemosensory activities of the rat carotid body and the intracellular calcium of glomus cells. Adv. Exp. Med. Biol., 475:655-661.

[4]Dejmkova, H., Stoica, A.I., Barek, J., et al., 2011. Voltammetric and amperometric determination of 2,4-dinitrophenol metabolites. Talanta, 85(5):2594-2598.

[5]Fongmoon, D., Pongnikorn, S., Chaisena, A., et al., 2014. Particulate matters collected from ceramic factories in Lampang Province affecting rat lungs. J. Zhejiang Univ.-Sci. B (Biomed. & Biotechnol.), 15(1):75-83.

[6]Grundlingh, J., Dargan, P.I., El-Zanfaly, M., et al., 2011. 2,4-Dinitrophenol (DNP): a weight loss agent with significant acute toxicity and risk of death. J. Med. Toxicol., 7(3):205-212.

[7]Jiang, J.K., Yuan, Z.H., Huang, W.D., et al., 2011. 2,4-Dinitrophenol poisoning caused by non-oral exposure. Toxicol. Ind. Health, 27(4):323-327.

[8]Licari, E., Calzavacca, P., Warrillow, S.J., et al., 2009. Life-threatening sodium valproate overdose: a comparison of two approaches to treatment. Crit. Care Med., 37(12):3161-3164.

[9]Liu, S., Lu, F., Wang, X., et al., 2011. Metabolomic study of a rat fever model induced with 2,4-dinitrophenol and the therapeutic effects of a crude drug derived from Coptis chinensis. Am. J. Chin. Med., 39(1):95-109.

[10]Lu, Y.Q., Jiang, J.K., Huang, W.D., 2011. Clinical features and treatment in patients with acute 2,4-dinitrophenol poisoning. J. Zhejiang Univ.-Sci. B (Biomed. & Biotechnol.), 12(3):189-192.

[11]Miranda, E.J., McIntyre, I.M., Parker, D.R., et al., 2006. Two deaths attributed to the use of 2,4-dinitrophenol. J. Anal. Toxicol., 30(3):219-222.

[12]Phillips, L., Singer, M.A., 2013. Peripheral neuropathy due to dinitrophenol used for weight loss: something old, something new. Neurology, 80(8):773-774.

[13]Politi, L., Vignali, C., Polettini, A., 2007. LC-MS-MS analysis of 2,4-dinitrophenol and its phase I and II metabolites in a case of fatal poisoning. J. Anal. Toxicol., 31(1):55-61.

[14]Robert, T.A., Hagardorn, A.N., 1983. Analysis and kinetics of 2,4-dinitrophenol in tissues by capillary gas chromatography-mass spectrometry. J. Chromatogr., 276(1):77-84.

[15]Robert, T.A., Hagardorn, A.N., 1985. Plasma levels and kinetic disposition of 2,4-dinitrophenol and its metabolites 2-amino-4-nitrophenol and 4-amino-2-nitrophenol in the mouse. J. Chromatogr., 344:177-186.

[16]Sebollela, A., Freitas-Corrêa, L., Oliveira, F.F., et al., 2010. Expression profile of rat hippocampal neurons treated with the neuroprotective compound 2,4-dinitrophenol: up-regulation of cAMP signaling genes. Neurotox. Res., 18(2):112-123.

[17]Shang, A.D., Lu, Y.Q., 2015. A case report of severe paraquat poisoning in an HIV-positive patient: an unexpected outcome and inspiration. Medicine (Baltimore), 94(8):e587.

[18]Sikma, M.A., van den Broek, M.P., Meulenbelt, J., 2012. Increased unbound drug fraction in acute carbamazepine intoxication: suitability and effectiveness of high-flux haemodialysis. Intensive Care Med., 38(5):916-917.

[19]Suozzi, J.C., Rancont, C.M., McFee, R.B., 2005. DNP 2,4-dinitrophenol: a deadly way to lose weight. JEMS, 30(1):82-89.

[20]Szczepańska-Sadowska, E., 1975. Osmotic thirst suppression during 2,4-dinitrophenol (DNP) hyperthermia in the dog. Pflugers Arch., 355(2):165-174.

[21]Wang, H., Wang, H.L., Jiang, W.F., et al., 2009. Photocatalytic degradation of 2,4-dinitrophenol (DNP) by multi-walled carbon nanotubes (MWCNTs)/TiO₂ composite in aqueous solution under solar irradiation. Water Res., 43(1):204-210.

[22]Wang, W.P., Liu, N., Kang, Q., et al., 2014. Simultaneous determination by UPLC-MS/MS of seven bioactive compounds in rat plasma after oral administration of Ginkgo biloba tablets: application to a pharmacokinetic study. J. Zhejiang Univ.-Sci. B (Biomed. & Biotechnol.), 15(11):929-939.

[23]Zhang, Q., Wu, W.Z., Lu, Y.Q., et al., 2012. Successful treatment of patients with paraquat intoxication: three case reports and review of the literature. J. Zhejiang Univ.-Sci. B (Biomed. & Biotechnol.), 13(5):413-418.