Kathryn T Kopec1, Caroline Freiermuth2, Susan Maynard3, Michael Beuhler4. 1. Department of Emergency Medicine, Division of Medical Toxicology, Carolinas Healthcare System, 1000 Blythe Blvd, MEB 3rd floor, Charlotte, NC, 28203, USA. ktkopec@gmail.com. 2. Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA. 3. Carolinas Pathology Group, Carolinas Healthcare System, Charlotte, NC, USA. 4. Department of Emergency Medicine, Carolinas Poison Center, Charlotte, NC, USA.
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.
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 DNPoverdose 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 salicylatetoxicity.
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