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Questions and Answers
What is the primary route of toxicity for Paraphenylene Diamine (PPD)?
What is the primary route of toxicity for Paraphenylene Diamine (PPD)?
Which of the following symptoms is least likely to occur during acute PPD poisoning?
Which of the following symptoms is least likely to occur during acute PPD poisoning?
What percentage of PPD intoxication cases reported signs of rhabdomyolysis?
What percentage of PPD intoxication cases reported signs of rhabdomyolysis?
Which of the following management techniques is recommended for respiratory failure due to PPD poisoning?
Which of the following management techniques is recommended for respiratory failure due to PPD poisoning?
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What is the range of the mortality rate associated with PPD intoxication?
What is the range of the mortality rate associated with PPD intoxication?
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In which of the following countries is PPD intoxication notably a major health problem?
In which of the following countries is PPD intoxication notably a major health problem?
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What age group accounts for the majority of PPD intoxication cases?
What age group accounts for the majority of PPD intoxication cases?
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Which laboratory investigation is NOT typically recommended for PPD intoxication?
Which laboratory investigation is NOT typically recommended for PPD intoxication?
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Study Notes
Paraphenylene Diamine (PPD) Hair Dye Poisoning
- PPD is a key ingredient in various hair dyes, used internationally to create different shades based on concentration.
- In Sudan, PPD is used to color hair and in henna (Lawsonia alba) for coloring palms and soles.
- PPD toxicity arises from skin absorption.
- PPD is an allergen.
- Systemic problems arise from accidental or intentional ingestion.
- A toxic dose is 3-5mg.
- Acute poisoning with PPD causes severe facial and neck edema, often needing tracheostomy.
- This results in swollen, hard tongues and potentially chocolate-brown urine.
- PPD intoxication can lead to a multi-system poisoning, causing rhabdomyolysis and acute renal failure (ARF), flaccid paralysis, severe gastrointestinal issues, cardiotoxicity, and arrhythmias.
- This type of poisoning, untreated, is often fatal.
- No specific antidote is available.
Clinical Presentation
- Key clinical symptoms include edema (94%), acute respiratory insufficiency (56%), tracheal intubation (72%), tracheostomy (21%), rhabdomyolysis signs (88%), gastrointestinal issues (53%), and oliguric acute renal failure (32%).
Epidemiology
- PPD poisoning is a significant health problem in Sudan, Morocco, and India.
- It's a frequent cause of suicidal attempts requiring hospitalization in Morocco.
- In adults, approximately 70-90% of PPD poisoning cases are linked to suicidal attempts.
- Mortality rates range from 10.6% to 38.7%.
- Statistics from a Khartoum ENT teaching hospital (1995-2005) show 3159 cases of PPD intoxication, averaging 287.1 per year.
- The most common age group affected is 15-24 years (52%).
- Females (80.7%) constitute the majority of cases, often due to suicidal attempts (87%).
Treatment & Management
- Early recognition, prompt referral and aggressive supportive treatment are crucial to reduce mortality.
- Management includes airway management (ABC), treating angioneurotic edema, supporting respiratory failure, providing fluids, gastric lavage, and renal dialysis.
Investigation
- Investigation should include blood tests for PPD, urine tests for PPD, renal function tests (RFT), liver function tests (LFT), and electrocardiography (ECG).
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Description
This quiz delves into the toxic effects and clinical implications of paraphenylene diamine (PPD) in hair dyes. Learn about the symptoms, potential systemic issues, and the dangers associated with exposure and ingestion. Understand the critical aspects of PPD toxicity and its life-threatening consequences.
