{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T11:38:16Z","timestamp":1768477096811,"version":"3.49.0"},"reference-count":18,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2018,11,1]],"date-time":"2018-11-01T00:00:00Z","timestamp":1541030400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2018,11,29]]},"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:p>There has been a resurgence in the use of 2,4-dinitrophenol, C<jats:sub>6<\/jats:sub>H<jats:sub>4<\/jats:sub>N<jats:sub>2<\/jats:sub>O<jats:sub>5<\/jats:sub> (DNP) recently as an illegal weight loss drug. We present a case of a healthy 25-year-old girl who took two tablets of DNP, purchased from an overseas online retailer. She was managed with aggressive, invasive cooling measures and 2.5\u2009mg kg<jats:sup>\u20131<\/jats:sup> dantrolene. Despite this, her temperature continued to rise exponentially to 41.5\u00b0C. Cardiac arrest occurred and resuscitation was unsuccessful. To our knowledge, this is the first reported case of the ineffective use of dantrolene in acute DNP poisoning. We review the pathophysiology of DNP toxicity and argue that the use of dantrolene therapy is biochemically implausible, based on poor evidence and likely to be futile. We have contacted the UK National Poisons Information Service (NPIS\/TOXBASE) to propose changes to the management of acute DNP toxicity.<\/jats:p>","DOI":"10.1136\/bcr-2018-225323","type":"journal-article","created":{"date-parts":[[2018,12,20]],"date-time":"2018-12-20T07:24:42Z","timestamp":1545290682000},"page":"e225323","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Dantrolene is not the answer to 2,4-dinitrophenol poisoning: more heated debate"],"prefix":"10.1136","volume":"11","author":[{"given":"Jason","family":"Van Schoor","sequence":"first","affiliation":[{"name":"Department of Anaesthetics, North Central School of Anaesthesia, London, UK"},{"name":"Division of Surgery of Surgery and Interventional Science, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esha","family":"Khanderia","sequence":"additional","affiliation":[{"name":"Division of Surgery, Cancer and Cardiovascular, Imperial College London Department of Surgery and Cancer, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Thorniley","sequence":"additional","affiliation":[{"name":"Department of Anaesthetics and Intensive Care, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, Greater London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,12,19]]},"reference":[{"key":"2025082707512806000_11.1.e225323.1","doi-asserted-by":"publisher","DOI":"10.1007\/s13181-011-0162-6"},{"key":"2025082707512806000_11.1.e225323.2","doi-asserted-by":"crossref","unstructured":"Holborow A , Purnell RM , Wong JF . Beware the yellow slimming pill: fatal 2,4-dinitrophenol overdose. BMJ Case Rep 2016;2016.doi:10.1136\/bcr-2016-214689","DOI":"10.1136\/bcr-2016-214689"},{"key":"2025082707512806000_11.1.e225323.3","unstructured":"Gordon L , Jackson G , Eddleston M , et al . National Poisons Information Service Report. 2016;2015."},{"key":"2025082707512806000_11.1.e225323.4","unstructured":"Barrett KE , Boitano S , Barman SM . Ganong\u2019s review of medical physiology. 23rd Edition. New York, USA: McGraw-Hill Professional Publishing, 2010."},{"key":"2025082707512806000_11.1.e225323.5","doi-asserted-by":"publisher","DOI":"10.1046\/j.1467-789X.2001.00043.x"},{"key":"2025082707512806000_11.1.e225323.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-185X.1953.tb01389.x"},{"key":"2025082707512806000_11.1.e225323.7","doi-asserted-by":"crossref","unstructured":"Stillwell W . Amsterdam; an introduction to biological membranes: composition, structure and function. Boston: Academic Press is an imprint of Elsevier 2016:579.","DOI":"10.1016\/B978-0-444-63772-7.00001-4"},{"key":"2025082707512806000_11.1.e225323.8","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1056\/NEJM193408302110901","article-title":"Biological actions of dinitrophenol and related compounds: a review","volume":"211","author":"Edsall","year":"1934","journal-title":"N Engl J Med Overseas Ed"},{"key":"2025082707512806000_11.1.e225323.9","first-page":"154","article-title":"Surviving a life-threatening 2,4-DNP intoxication: \u2019Almost dying to be thin'","volume":"69","author":"van Veenendaal","year":"2011","journal-title":"Neth J Med"},{"key":"2025082707512806000_11.1.e225323.10","first-page":"652","article-title":"Annual Meeting - exhibits and poster session iv, abstracts 176\u2013234","volume":"40","author":"2002 North American Congress of Clinical Toxicology","year":"2002","journal-title":"J Toxicol"},{"key":"2025082707512806000_11.1.e225323.11","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s13181-017-0599-3","article-title":"Abstracts from the 2017 American College of Medical Toxicology (ACMT) Annual Scientific Meeting","volume":"13","author":"American College of Medical Toxicology (ACMT)","year":"2017","journal-title":"J Med Toxicol"},{"key":"2025082707512806000_11.1.e225323.12","doi-asserted-by":"crossref","first-page":"240","DOI":"10.3109\/15563651003740240","article-title":"Abstracts of the 2010 International congress of the european association of poisons centres and clinical toxicologists, 11-14 May 2010, Bordeaux, France","volume":"48","author":"International Congress of the European","year":"2010","journal-title":"Clin Toxicol"},{"key":"2025082707512806000_11.1.e225323.13","doi-asserted-by":"publisher","DOI":"10.1136\/emj.2009.072892"},{"key":"2025082707512806000_11.1.e225323.14","doi-asserted-by":"crossref","DOI":"10.1080\/15563650600584709","article-title":"Letter To The Editor: \u201cComment on \u201cPediatric Fatality Following Ingestion of Dinitrophenol: Postmortem Identification of a \u2018Dietary Supplement\u2019\u201d\u201d","volume":"44","author":"Barker","year":"2006","journal-title":"Clin Toxicol"},{"key":"2025082707512806000_11.1.e225323.15","first-page":"137","article-title":"Calcium gain during postischemic reperfusion. The effect of 2,4-dinitrophenol","volume":"131","author":"Elz","year":"1988","journal-title":"Am J Pathol"},{"key":"2025082707512806000_11.1.e225323.16","unstructured":"Toxbase. The primary clinical toxicology database of the national poisons information service. 2017 https:\/\/www.toxbase.org"},{"key":"2025082707512806000_11.1.e225323.17","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aep033"},{"key":"2025082707512806000_11.1.e225323.18","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2004.03658.x"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bcr-2018-225323","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-225323","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T14:51:34Z","timestamp":1756306294000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-225323"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,11]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2018,12,19]]},"published-print":{"date-parts":[[2018,11]]}},"alternative-id":["10.1136\/bcr-2018-225323"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-225323","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,11]]}}}