CASE REPORT Death within 44 days of 2,4-dinitrophenol intake Fred Zack 1 & Verena Blaas 1 & Christoph Goos 2 & Daniel Rentsch 1 & Andreas Büttner 1 Received: 7 March 2016 /Accepted: 29 April 2016 # Springer-Verlag Berlin Heidelberg 2016 Abstract We report the case of a 50-year-old obese man (115 kg body mass at 1.77 m height), who started taking 2, 4-dinitrophenol (DNP) for weight reduction 44 days before his death. After 43 days of taking DNP, the man showed signs of intoxication with nausea, vomiting, and attacks of sweating. After admission to a hospital where the man concealed his DNP intake, sinus tachycardia, tachypnea, and general un- rest were noted. The patient died 9 h after the onset of those symptoms. Upon autopsy, a yellowing of palms and soles was striking. The initially uncertain cause of death could only be clarified by the forensic toxicological examinations and subsequent police investigations. Finally, the man had a total intake of 12.3 g of DNP in 44 days which is rela- tively high compared to other lethal DNP intoxications. Keywords Diet . 2,4-dinitrophenol (DNP) . Intoxication . Tachycardia . Tachypnea . Cause of death Introduction 2,4-Dinitrophenol (DNP) is a yellow, crystalline solid which was used for the production of ammunition in France during the First World War. Considerable symptoms of poisoning (like nausea, sweating, and headaches) and a reduction of body weight were observed in workmen [1, 2]. So the idea arose to use DNP as an anti-obesity drug [3, 4]. An increase of the basal metabolic rate by 50 % in healthy humans is consid- ered to be the reason for the weight reduction [5]. DNP is an artificial uncoupler of the oxidative phosphorylation and blocks the creation of energy rich phosphates (as ATP) [6, 7]. In the 1930s, serious side effects were observed in patients treated with DNP [2, 8] so the United States Food and Drug Administration (FDA) revoked the approval for DNP- containing drugs to the present day [9, 10]. In Germany, the distribution of DNP as a pharmaceutical or diet aid is also prohibited. Case report A 50-year-old-man was found in his bed by his wife about 10:30 p.m. He had complained about nausea and dizziness, sweated heavily, and had been vomiting a yellow liquid short- ly before. Within the following 90 min, the situation did not improve, so his wife called an ambulance. After admission to a department of Internal Medicine at 12:30 a.m., the man was responsive, restless, sweating cold, and had a tachypnea of 33/ minute. He denied the consumption of alcohol or the intake of illicit drugs or medication. Essential clinical results are the following: low-grade alkalosis (pH 7.74, pCO 2 3.3 kPa) cor- relating to a hyperventilation, blood pressure 120/70 mmHg, body temperature 36.2 °C, sinus tachycardia 113 bpm), slight leukocytosis (13.7 10 9 G/L), GPT 53 U/L, creatinine 147 μmol/L, glucose 10.2 mmol/L, and lactate 4.0 mmol/L. Neither these results nor the physical examination or the ECG led to any suspected diagnosis. Therefore, a symptomatic treatment including electrolyte fluid, sodium chloride solution (0.9 %), pantoprazole, and dimenhydrinate was initiated and monitoring in the emergency department continued. With in- creasing restlessness, the man finally admitted upon asking * Andreas Büttner andreas.buettner@med.uni-rostock.de 1 Institute of Legal Medicine, Rostock University Medical Center, Rostock, Germany 2 Clinics for Internal Medicine, Rostock University Medical Center, Rostock, Germany Int J Legal Med DOI 10.1007/s00414-016-1378-4