Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 7193  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Articlesmenu-bullet Search Instructions Online Submission Subscribe Etcetera Contact
 
  NAVIGATE Here 
  Search
 
 :: Next article
 :: Previous article 
 :: Table of Contents
  
 RESOURCE Links
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::Related articles
 ::  Article in PDF (75 KB)
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 

  IN THIS Article
 ::  Abstract
 ::  Case History
 ::  Discussion
 ::  References
 ::  Article Tables

 Article Access Statistics
    Viewed10807    
    Printed300    
    Emailed2    
    PDF Downloaded299    
    Comments [Add]    
    Cited by others 19    

Recommend this journal


 


 
CASE REPORT
Year : 2007  |  Volume : 53  |  Issue : 3  |  Page : 181-182

Paraphenylene diamine ingestion: An uncommon cause of acute renal failure


Department of Nephrology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad - 500 082, India

Date of Submission07-Mar-2006
Date of Decision05-Apr-2006
Date of Acceptance17-Sep-2006

Correspondence Address:
R Ram
Department of Nephrology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad - 500 082
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0022-3859.33860

Rights and Permissions


 :: Abstract 

Paraphenylene diamine (PPD) is a major component of hair dyes. The aim is to study the renal manifestations and outcome of PPD consumption. During a four-year period from 2002 to February 2006, 10 persons were admitted to our Institute after consuming a hair dye in a suicidal bid. The percentage of ARF due to PPD at our Institute was 0.95%. Seven patients out of 10 (70%) who consumed PPD developed ARF. All 10 patients, including the patients who had normal renal function had features of rhabdomyolysis. Two patients required ventilator support for respiratory distress and two more required tracheostomy due to upper airway tract edema. One patient has expired after two sessions of dialysis. Renal biopsy in two patients (one, postmortem) showed acute tubular necrosis along with presence of casts in tubules due to myoglobin.


Keywords: Acute renal failure, paraphenylene diamine


How to cite this article:
Ram R, Swarnalatha G, Prasad N, Dakshinamurty K V. Paraphenylene diamine ingestion: An uncommon cause of acute renal failure. J Postgrad Med 2007;53:181-2

How to cite this URL:
Ram R, Swarnalatha G, Prasad N, Dakshinamurty K V. Paraphenylene diamine ingestion: An uncommon cause of acute renal failure. J Postgrad Med [serial online] 2007 [cited 2023 Sep 29];53:181-2. Available from: https://www.jpgmonline.com/text.asp?2007/53/3/181/33860


The aim is to study the renal manifestations and outcome of paraphenylene diamine consumption.

Paraphenylene diamine, (PPD) a coal-tar derivative, is a chemical substance that is widely used as a permanent hair dye. The major oxidation product of PPD is Bondrowski's base, which is allergenic, mutagenic and highly toxic. The first case of PPD poisoning was reported in a hairdresser in 1924 following exposure due to PPD dye handling. [1] It is consumed to commit suicide in the Telengana region of Andhra Pradesh, India, because of its easy availability. An 11-year (1992-2002) retrospective study of PPD poisoning reported to the Poison Control Centre of Morocco has revealed 374 cases with a female predominance (77%), of which 21.1% of poisoning cases were fatal. [2]


 :: Case History Top


During a four-year period from 2002 to February 2006 10 persons were admitted to our Institute after consuming a hair dye in a suicidal bid. All the patients were evaluated with hemogram, liver and renal function tests and ultrasound abdomen. Renal biopsy, including one postmortem biopsy was performed in two patients.

Ten persons were admitted to our Institute after consuming a hair dye. Eight were males and two girls. The mean age was 23.2 ± 7.6 years (14 to 34 years). All save three patients (70%) presented on the day of consumption of the poison.

At admission, six (60%) patients had cervicofacial edema, all 10 (100%) patients had chocolate brown-colored urine and seven (70%) had oliguria. Body pains were complained by seven patients (70%), one patient (10%) had muscular edema and proximal muscle weakness.

The percentage of ARF due to PPD at our Institute was 0.95%. All 10 (100%) patients, including the patients who had normal renal function had features of rhabdomyolysis. Two (20%) patients required ventilator support. Four (40%) more patients underwent tracheostomy, due to upper airway tract edema, but have not required any ventilator support. Respiratory care was required in these six patients before they developed renal failure. Seven (70%) patients, who recovered from ARF, required 3.5 ± 2.3 (range: 1 to 6) sessions of hemodialysis and the serum creatinine normalized in four weeks. Two (20%) patients required ventilator support for 10 ± 5 days. The results of biochemical investigations are depicted in [Table - 1].

In one patient renal biopsy was done, as there was undue delay in recovery. It showed acute tubular necrosis along with presence of casts in tubules due to myoglobin.

The electrocardiogram was normal in nine patients. One patient had ventricular extra systoles only on the first day of admission. It was normal in the patient who expired. Echocardiogram was done only in four patients. It was normal in all.

One (10%) patient expired after two sessions of dialysis, while on ventilator. The cause of death as evidenced by postmortem (done for legal purpose) was acute respiratory distress syndrome (ARDS) as there was organized fibrin material in the alveoli. The microscopic sections of the kidney showed myoglobin casts in tubules.


 :: Discussion Top


Our results show that clinical manifestations of systemic PPD intoxication are dominated by cervical and upper respiratory tract edema, muscular edema, rhabdomyolysis and acute renal failure. In the Kallel et al. [3] study the frequency of cervical and upper respiratory tract edema and acute renal failure was 68.4% and 47.4% respectively. In that study oral-tracheal intubation was performed in 68.4% of patients and emergency tracheostomy in 15.8% of patients.

The characteristic angioedema of the face and neck, on initial presentation with difficulty in breathing, secondary to upper respiratory tract edema and chocolate brown color of the urine could be a confirmative evidence of PPD poisoning in the absence of laboratory facilities and when history is lacking in case of emergency. [4] Other reported features are rigidity and tenderness of limbs secondary to rhabdomyolysis and ARF, leukocytosis, anemia secondary to hemolysis, hemoglobinemia and hemoglobinuria. Sudden death appears to be due to myocarditis and arrhythmia. [5] Myocardial rhabdomyolysis [6] and shock [7] have also been described. Hypotensive shock is recognized and is associated with poor prognosis. [4]

In the earliest report of PPD from India, two patients had renal biopsy proven acute tubular necrosis. [8] Renal biopsies were also performed, as inferred from an abstract presented at the Indian Society of Nephrology, 2004, (unpublished data), in four patients of PPD intoxication and revealed acute tubular necrosis (ATN) in three patients and acute interstitial nephritis in one patient. Rhabdomyolysis has not been described in both the studies. The pathogenesis of ATN, independent of rhabdomyolysis appears to be due to the aromatic structure of PPD making it easily reabsorbed and concentrated in tubules. [9] When the toxicity was in small doses like hair dye, membranous nephropathy has been reported owing to in situ formation of immune complex. [10] Rhabdomyolysis, was, however confirmed in postmortem biopsy in one patient who died of asphyxia following PPD intoxication. [6] While rhabdomyolysis was reported [3] to occur in all patients who consumed PPD, ARF was variable from 47.4-100%. [3] Death is mainly due to acute respiratory distress and so rapid has been its onset that tracheostomy at presentation is recommended. [9] The major challenge to life in later stages is renal failure [4] and myocarditis. [5]

PPD consumption is an uncommon cause of ARF due both to ATN and rhabdomyolysis. It also causes respiratory embarrassment due to cervical and upper respiratory tract edema requiring immediate respiratory care. The majority of patients recover with early respiratory care and dialytic support.

 
 :: References Top

1.Nott HW. Systemic poisoning by hair dye. Br Med J 1924;1:421-2.  Back to cited text no. 1    
2.Filali A, Semlali I, Ottaviano V, Furnari C, Corradini D, Soulayman R. A restrospective study of acute systemic poisoning of Paraphenylenediamine (occidental takawt) in Morocco. Afr J Trad CAM 2006;3:142-9.  Back to cited text no. 2    
3.Kallel H, Chelly H, Dammak H, Bahloul M, Ksibi H, Hamida CB, et al. Clinical manifestations of systemic paraphenylene diamine intoxication. J Nephrol 2005;18:308-11.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Ashar A. Acute Angioedema in paraphenylenediamine poisoning. J Pak Med Assoc 2003;53:120-2.  Back to cited text no. 4  [PUBMED]  
5.Zeggwagh AA, Abouqal R, Abidi K, Madani N, Zekraoui A, Kerkeb O. Left ventricular thrombus and myocarditis induced by paraphenylenediamine poisoning. Ann Fr Anesth Reanim 2003;22:639-41.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Ababou A, Ababou K, Mosadik A, Lazreq C, Sbihi A. Myocardial rhabdomyolysis following paraphenylene diamine poisoning. Ann Fr Anesth Reanim 2000;19:105-7.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Abdulla KA, Davidson NM. A woman who collapsed after painting her soles. Lancet 1996;348:658.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]
8.Chugh KS, Malik GH, Singhal PC. Acute renal failure following paraphenylene diamine [hair dye] poisoning: Report of two cases. J Med 1982;13:131-7.  Back to cited text no. 8  [PUBMED]  
9.El-Ansary EH, Ahmed ME, Clague HW. Systemic toxicity of para-phenylene diamine. Lancet 1983;1:1341.  Back to cited text no. 9  [PUBMED]  
10.Aburaya J. A case of membranous nephropathy exacerbated after the use of hair dye. Nephron 1996;74:449-51.  Back to cited text no. 10  [PUBMED]  



 
 
    Tables

  [Table - 1]

This article has been cited by
1 Hair Dye Ingredients and Potential Health Risks from Exposure to Hair Dyeing
Lin He, Freideriki Michailidou, Hailey L. Gahlon, Weibin Zeng
Chemical Research in Toxicology. 2022;
[Pubmed] | [DOI]
2 STUDY TO EVALUATE THE ACUTE KIDNEY INJURY IN PATIENTS WITH POISONING
DHARMENDRA KATARIA, MUKESH SINGH TOMAR, KAILASH CHAREL
Asian Journal of Pharmaceutical and Clinical Research. 2022; : 28
[Pubmed] | [DOI]
3 Paraphenylene diamine exacerbates platelet aggregation and thrombus formation in response to a low dose of collagen
Younes Zaid,Fatimazahra Marhoume,Nezha Senhaji,Kevin Kojok,Hicham Boufous,Abdallah Naya,Mounia Oudghiri,Youssef Darif,Norddine Habti,Soukaina Zouine,Fekhaoui Mohamed,Abderahmane Chait,Abdellah Bagri
The Journal of Toxicological Sciences. 2016; 41(1): 123
[Pubmed] | [DOI]
4 Hair dye poisoning: An unusual encounter
Rajjan Tiwari, Alok Ahlawat
Indian Journal of Critical Care Medicine. 2014; 18(6): 402
[Pubmed] | [DOI]
5 The effects of henna (hair dye) on the embryonic development of zebrafish (Danio rerio)
Bangeppagari Manjunatha,Peng Wei-bing,Liu Ke-chun,Shambanagouda R. Marigoudar,Chen Xi-qiang,Wang Xi-min,Wang Xue
Environmental Science and Pollution Research. 2014;
[Pubmed] | [DOI]
6 a prospective study on prevalence of poisioning cases - focus on vasmol poisoning
gella, u. and shilpa, n. and chandrababu, s. and rathan shyam, m. and venkata subbiah, m.
international journal of pharmacy and pharmaceutical sciences. 2013; 5(suppl.4): 405-411
[Pubmed]
7 study of hair dye poisoning cases in a government medical college hospital, madurai, tamilnadu
sudharson, t. and magendran, j. and mestri, s.c. and siddapur, k.r.
journal of south india medicolegal association. 2012; 5(1): 8-13
[Pubmed]
8 paraphenylene diamine poisoning
jesudoss prabhakaran, a.c.
journal of natural science, biology and medicine. 2012; 3(2): 199-200
[Pubmed]
9 a retrospective study on the biochemical profile of self poisoning with a popular indian hair dye
prasad, n.r. and bitla, a.r.r. and manohar, s.m. and devi, n.h. and srinivasa rao, p.v.l.n.
journal of clinical and diagnostic research. 2012; 5(7): 13431346
[Pubmed]
10 Hair Dye Poisoning in a Paediatric Patient
Jolly Chandran,Rimi Manners,Indira Agarwal,Kala Ebenezer
Case Reports in Pediatrics. 2012; 2012: 1
[Pubmed] | [DOI]
11 Hair Dye Related Acute Kidney Injury – A Clinical and Experimental Study
Yanala Sandeep Reddy,Shaik Abbdul Nabi,Chippada Apparao,Chinthamaneni Srilatha,Yadla Manjusha,Parvathina Sri Ram Naveen,Chennu Krishna Kishore,Anappindi Sridhar,Vishnubotla Siva Kumar
Renal Failure. 2012; 34(7): 880
[Pubmed] | [DOI]
12 hair dye poisoning in bundelkhand region (prospective analysis of hair dye poisoning cases presented in department of medicine, mlb medical college, jhansi)
jain, p.k. and agarwal, n. and kumar, p. and sengar, n.s. and agarwal, n. and akhtar, a.
journal of association of physicians of india. 2011; 59(7): 415-419
[Pubmed]
13 oxidative stress and anti-oxidant status in hair dye poisoning
sutrapu, s. and jagadeeshwar, k. and nagulu, m. and vidyasagar, j.
international journal of pharmacognosy and phytochemical research. 2011; 3(1): 1-5
[Pubmed]
14 clinical profile of acute paraphenylenediamine intoxication in egypt
shalaby, s.a. and elmasry, m.k. and abd-elrahman, a.e. and abd-elkarim, m.a. and abd-elhaleem, z.a.
toxicology and industrial health. 2010; 26(2): 81-87
[Pubmed]
15 Hair dye poisoning and the developing world
Sampathkumar, K. and Yesudas, S.
Journal of Emergencies, Trauma and Shock. 2009; 2(2): 129
[Pubmed]
16 Systemic toxicity of paraphenylenediamine
Soni, SS and Nagarik, AP and Dinaker, M. and Adikey, GK and Raman, A.
Indian Journal of Medical Sciences. 2009; 63(4): 164-166
[Pubmed]
17 Hair dye ingestion - An uncommon cause of acute kidney injury
Sahay, M., Vani, R., Vali, S.
Journal of Association of Physicians of India. 2009; 57(11)
[Pubmed]
18 Paraphenylene diamine-induced acute renal failure: Prevention is the key.
Bhargava, P.
Journal of postgraduate medicine. 2008; 54(1): 60-61
[Pubmed]
19 Myocardial Damage in Hair Dye Poisoning-An Uncommon Presentation
Singh, N. and Jatav, OP and Gupta, RK and Tailor, MK
The Journal of the Association of Physicians of India. 2008; 56((JUNE)): 463-464
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article
Online since 12th February '04
© 2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow