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Prospective study of clinical profile in hair dye poisoning (PPD) with special reference to electrocardiographic manifestations

Dharmendra Tiwari, O P Jatav, Manish Dudani.




Abstract

Background: High suicide rate is reported in India, and poisoning seems to be main cause in majority of these suicide cases. An enhanced rate is seen in poisoning by hair dye, and in few places, it comprises a huge part of the poisoning cases.

Objective: To study the clinical profile, electrocardiographic (ECG) changes, and biochemical parameters of patients presenting with hair dye poisoning.

Material and Methods: A prospective study of 50 indoor patients admitted to poison ward of Department of Medicine, GR Medical College and JA Group of Hospitals, Gwalior, Madhya Pradesh, India, was done from August 1, 2008, to October 30, 2009. The parameters studied in all the patients were cause of ingestion, compound involved, time elapse between ingestion and admission to the hospital, duration of hospital stay, need for assisted ventilation, and cardiac manifestations at the time of presentation and during hospital stay. Routine investigations such as renal function, liver function tests, creatinine phosphokinase (CPK) levels, and cardiac marker test (CPK-MB) were done. ECG was done for all the patients daily to observe rate, rhythm, ST/T abnormalities, conduction defects, and P-R and Q-T intervals disturbances.

Result: Of 50 patients included in the study, 38 (76%) patients were between the age group of 15–25 years, and there was a female predominance (60%); 55% of male population was from the rural area, and 93.33% female belonged to urban area. Twenty-eight (56%) patients reached hospital within 6 h of hair dye ingestion. Angioneurotic edema was the most common clinical finding. Renal functions were deranged in 38% and liver functions in 18% and CPK-MB was raised in 82% patients. ECG changes were observed in 90% patients of which ST/T changes were most common. Ten (20%) patients died in this study.

Conclusion: The hair dye poisoning is not so uncommon and is associated with effects on vital organs resulting in derangements of renal, hepatic and cardiac functions. Angioneurotic edema and myocarditis can be fatal. ECG changes and elevated CPK-MB are found in majority of the patients.

Key words: Hair dye, paraphenylene-diamine, PPD, myocarditis, angioneurotic edema






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