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Anaesth Pain & Intensive Care. 2017; 21(4): 43-47


Paraphenylene diamine poisoning: Clinical Presentations and Outcomes

Syed Aftab Haider, Atqua Sultan, Zaira Salman, Salman Waris, Yousaf Bandesha.

Abstract
ABSTRACT:
Background:
Para-phenylene-diamine (PPD) also known as Kaala pathar has become an emerging and life threating poisoning in Pakistan as well as in many other Asian and African nations. Aim of this study is to recognize the etiological factors, clinical features and outcomes of patients with PPD poisoning.
Methods:
This observational prospective analysis included 32 patients who present in ICU of Nishtar Hospital Multan. Patients were first managed conservatively by giving I.V. fluids, diuretics, antihistamines and steroids; tracheal intubation or tracheostomy was done only when needed. Univariate analysis was used to determine the independent variables of mortality after PPD poisoning and odds ratios were calculated.
Results:
Cervico-facial edema followed by oral erythema and sore throat were most common clinical presentation of patients at the time of admission in ICU with the incidence rate of 93.8%, 81.3% and 75.0% respectively. Acute renal failure occurred in 34.4% patients and acute hepatitis in 18.75% patients. In-hospital mortality was 9 (28.1%). Male gender (odds ratio 16.62), dysphagia (odds ratio 9.92), hyperkalemia (odds ratio 84.0), development of cardiogenic shock (odds ratio 36.75), acute renal failure (odds ratio 16.62) and acute hepatitis (odds ratio 27.50) were the independent predictors of mortality after PPD poisoning.
Conclusion:
Paraphenylene-diamine (Kala Pathar) poisoning has become a major source of suicide with very high mortality rate. Male gender, dysphagia at the time of presentation, hyperkalemia, cardiogenic shock, acute renal failure and acute hepatitis are the independent predictors of mortality after PPD poisoning.

Key words: Para-phenylene-diamine, cervico-facial edema, tracheostomy, mortality



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