Clinical Profile and Outcome of Paraphenylene Diamine Poisoning.

Objective: To determine the clinical presentation, complications, and outcome of paraphenylene diamine (PPD) poisoning in patients presenting to Nishtar Hospital, Multan.

Study Design: Descriptive study.

Place And Duration Of Study: Medical Unit II and III, Nishtar Hospital, Multan, from April 2015 to September 2016.

Methodology: All adult patients admitted with history of paraphenylene diamine ingestion were evaluated for clinical features, complications, and outcomes on a pre-designed proforma.

Results: Out of 122 patients, 95 were females (77.9%) and 101/122 patients had ingested the poison with an intention of suicide or self harm (82.8%). The mean age of presentation was 23.21 ±8.2 years. Cervico-facial edema was the chief presenting complaint, seen in 116/122 (95%) of patients, with median of 2 (interquartile range=3) for time of onset after ingestion of poison. Tracheostomy was needed in 95/116 (82%) patients with cervico-facial edema. Other common complaints were dark urine in 95/122 (77.9%) and pain in limbs in 98/122 (80.3%) patients. Rhabdomyolysis was evident in 91/122 (74.5%) patients at admission. Acute kidney injury developed in 37/122 (30.3%) patients. Among these, 16 (43.2%) patients required haemodialysis. Myocarditis was diagnosed in 33/122 (27%) patients. The median for hospital stay was 9.50 days (interquartile range=6.25). The mortality was 34/122 (28%). Ventricular arrhythmias were the commonest cause of death in 25/34 (73.5%), followed by renal failure in 5/34 (14.7%), asphyxia in 2/34 (5.88%), and aspiration pneumonia in 2/34 (5.88%) patients.

Conclusion: Paraphenylene diamine is an emerging domestic poison in Pakistan, with a high morbidity and mortality.