Clinical Presentation, Complication and Outcome of Black Stone (Paraphenylene Diamine) Poisoning

Abstract

Introduction: In recent time, developing countries of South Asia and Africa have seen significant increase in ingestion of Para-Phenylene Diamine (PPD) locally known as Kala Pathar either accidental or for suicide. Through this study we aim to study the clinical presentations and outcomes among patients who have ingested PPD. Method: This retrospective case series study was conducted in a tertiary care hospital of Pakistan, from April 2013 to August 2017. Data of patients of PPD poisoning was archived from the hospitals medical records. Around 174 consecutive cases were included in the study. Patients were evaluated based on self-administrated proforma. Result: Out of 174 cases of PPD poisoning that were identified, 57(32.8%) were males and 117(67.2%) were females. Approximately 170 (97.8%) patients used PPD for suicidal intention. The most common presentation was facial swelling which was present in 144(82.8%) patients followed by dysphagia in 143(82.2%) patients. Complications include metabolic acidosis in 50 (28.7%) patients and aspiration pneumonia in 36 (20.7%) patients. A total of 101 (58%) improved, while others were either referred or left against medical advice (LAMA). Conclusion:Increasing incidence of ingestion of PPD for suicide warrants the regulatory authorities to restrict the use of PPD in hair dyes and implement strict measures to educate masses and curtail the easy access of such poisonous substances among common people.