2,4-dinitrophenol intoxication: Lack of adsorption despite prior literature suggesting efficacy

2,4-Dinitrophenol (DNP) is a potent mitochondrial uncoupler associated with life-threatening hypermetabolism and refractory hyperthermia. It remains widely available online despite repeated regulatory warnings and numerous reported fatalities. We report a severe DNP intoxication with multi-organ dysfunction in a 22-year-old man. Continuous veno-venous hemodialysis combined with CytoSorb® hemoadsorption (HA) was initiated as previous reports suggest a benefit associated with these techniques. Serial measurements were performed to assess extracorporeal clearance, which was calculated using pre- and post-adsorber blood sampling. No meaningful reduction in plasma concentration or adsorber-based clearance was observed, indicating minimal extracorporeal elimination of DNP. The patient improved under supportive care including active cooling and recovered fully. This case highlights that declining serum concentration alone are not sufficient to evaluate effectiveness of HA for toxin removal and emphasize the importance to use EXTRIP dialyzability criteria. Overall, HA with CytoSorb® demonstrated no measurable DNP elimination.