EFFECT OF HAIR DYE POISONING ON CALCIUM, PHOSPHORUS METABOLISM AND EFFECTS OF PARENTRAL HYDROCORTISONE, ADRENAL, SODIUM BICARBONATE AND CHLORPHENIRAMINE ON MORTALITY AND MORBIDITY OF HAIR DYE POISONING

Dr. P.K. Jain; Dr. Narayan Pandey

Volume : IX, Issue : IV, April - 2020

EFFECT OF HAIR DYE POISONING ON CALCIUM, PHOSPHORUS METABOLISM AND EFFECTS OF PARENTRAL HYDROCORTISONE, ADRENAL, SODIUM BICARBONATE AND CHLORPHENIRAMINE ON MORTALITY AND MORBIDITY OF HAIR DYE POISONING

Dr. P. K. Jain, Dr. Narayan Pandey

Abstract :

Introduction: In India pesticides are the most commonly used poisoning agents. In Bundelkhand region incidence of poisoning is also high. A unique type of poisoning is seen in this region which is hair dye poisoning. Hair dye is very cheap and freely available, making it an attractive option for suicide. Most of popular types of hair dyes are permanent oxidation dyes which has Paraphenylenediamine (PPD) as its main active ingredient. Aim: Effect of parenteral hydrocortisone adrenaline, sodium bicarbonate and chlorpheniramine on morbidity and mortality of hair dye poisoning. Material and Methods: The present study was conducted at department of medicine, M.L.B. Medical College, Jhansi over a period between March 2018 to Aug 2019. Study included 100 patients of hair dye poisoning presenting to emergency department of Maharani Laxmi Bai Medical College. All patients were subjected to detailed history, general and systemic examination and data was statistically analyzed. Results: Out of 100 cases in present study of PPD ingestion, 53 cases (53%) were female and 47 cases (47%) were male. Majority 43 pts (43%) were from age group of 26–35Yrs and presentation of hair dye poisoning was very rare (7%) in age group >45 years. Mean age of study group was 29.33yrs. Mean age of males was 29.85�9.76yrs and mean age of females was 28.87�9.83yrs. In our study of 100 cases all were due to ingestion of hair dye. Maximum number of cases were due to suicidal intent 84 cases (84%) and 16 (16%) cases were due to accidental ingestion. Most common abnormal ECG finding is St–T changes, myocarditis in 18 pts (18%) followed by adycardia in 14 pts (14.5%), followed by sinus tachycardia 11%. 74 pts (74%) had serum calcium in range of 7–9 mg% and only 1 pts (1%) had severe hypocalcemia with serum calcium levels below 7 mg%. In group A, the mean serum calcium level (total) was 8.095 �0.593 mg%. Mean serum calcium level in group B was 8.83�0.64mg%. In group A, the mean serum phosphorus level was 4.066 � 0.91 mg%. Serum phosphorus level in group B was 3.78� 0.51 mg%. Maximum number of cases (77%) were having normal ABG, 16 pts had metabolic acidosis & 7 pts had metabolic alkalosis. serum CPK levels were within normal range in 79 patients (79.0%). 1 patient (1%) had mildly elevated serum CPK (241–1000 IU/L) (belongs to high PPD concentration hair dye). 12 patients (12%) had moderately elevated serum CPK (1001–10000 IU/L) (belongs to high PPD concentration hair dye). 6 patients (6.0%) had severely elevated serum CPK (10001–1 lac IU/L) (belongs to high PPD concentration hair dye). Only 2 patients (2.0%) had serum CPK values > 1 lac IU/L. There was rise in serum creatinine in 21 patients (21.0%). In group A mean serum creatinine level was 2.48 �1.92 mg% and 0.908�0.311 in group A and group B respectively. Only 4 cases have expired which is from group A i.e. high concentration PPD hair dye. In Group A (30) cases have get symptomatic treatment as well as methyl prednisolone, s/c adrenaline, NaHCO3, Chlorpheniramine, so only 13% (4/30 cases) were died which is very low for high concentration PPD hair dye Conclusion: PPD concentration increases there is decrease in both systolic and diastolic blood pressure. Only 4 cases have expired which is from group A i.e. high concentration PPD hair dye.