Paraphenylenediamine poisoning: clinical features, complications and outcome in a tertiary care institute

Abstract

Background: Paraphenylenediamine (PPD) is a substance present in hair dyes which is metabolized in the body cytochrome P450 system, and is further oxidized to a toxic product that can lead to multi organ failure
Objective: To determine the frequency of clinical features, complications and outcome in PPD intoxicated patients admitted to the ICU of Peoples Medical College Hospital Nawabshah S.B.A, Sindh, Pakistan.
Methodology: This retrospective study was conducted at the Intensive Care Unit of Peoples Medical College Hospital, Nawabshah between January 2011 and December 2016. A detailed clinical history was recorded including demographic profile, symptoms signs and outcome. Diagnosis of PPD poisoning was based on history of ingestion and clinical manifestations
Results: There were 1032 patients of hair dye (PPD) poisoning. There were 350 (33.91%) males and 682 (66.09%) females (mean age 22.08±8.42 years). Dysphagia was observed in 1032 (100%), cervicofacial swelling in 939 (90.99%), dyspnea in 927 (89.82%), generalized body ache with muscle weakness in 712 (68.99%), decreased urine output in 185 (17.93%) and chocolate brown color urine in 776 (75.19%) cases. Regarding the reason of ingestion of poison, suicidal intention was observed in 1021 (98.94%), accidental ingestion in 8 (0.77%), homicidal in 1 (0.097%) and in 2 (0.193%) patient’s intention could not be determined. All patients consumed local stone (black stone) based hair dye by oral route. Thirty nine patients were lost to follow up. Mortality rate in rest 993 patients was 14.5% (n=139) in male and 17.52% (n=172) in females.