When your breath dyes away

Yıl 2020, , 119 - 121, 28.12.2020

Mohammed Ismaıl Nızamı

https://doi.org/10.33706/jemcr.804013

Öz

Introduction
The use of hair dye for deliberate self-harm is seen in many parts of the world. Paraphenylenediamine (PPD) is the main constituent of hair dye formulations and is found to be highly toxic. The other constituents are resorcinol, propylene glycol, sodium ethylene diamine tetra acetic acid, preservatives and perfume. Clinical features of PPD poisoning include severe cervicofacial odema, chocolate colored urine, oliguria and shock. Management is mainly supportive and there are no specific antidotes.
Case report
A young lady was brought to ED with complains of sudden onset swelling of chin, neck and tongue. She was sitting upright with hoarseness of voice. She had edema over her chin and lower half of face extending to the neck. The tongue was hard and edematous. As her symptoms worsened she asked for a piece of paper to write and wrote “VASOMOL”, which is a brand name for the hair dye containing paraphenelyenediamine.
Conclusion
The difficult airway management is an essential skill needed for the emergency physician. Hair dye poisoning has been known to cause severe angioneurotic odema. Ours is a case of PPD poisoning which presented with life threatening airway odema. We followed the ABCD assessment and on determining the need for airway control, we planned a surgical airway immediately.

Anahtar Kelimeler

acute tubular necrosis, paraphenylenediamine, rhabdomyolysis, angioneurotic oedema

Kaynakça

• 1. Verma R, Tewari N, Jaiswal S, Rastogi V, Singh D. Fatal poisoning caused by oral ingestion of a hair dye. Internet J Emerg Intensive Care Med. 2008;11(1):2.
• 2. Ashraf W, Dawling S, Farrow LJ. Systemic Paraphenylene-diamine (PPD) Poisoning: a case report and review. Hum Exp Toxicol. 1994;13(3):167-70.
• 3. Patra, Ambika P, Shaha KK, Rayamane AP, Dash SK, Mohanty MK et al. Paraphenylenediamine Containing Hair Dye: An Emerging Household Poisoning. The American journal of forensic medicine and pathology. 2015;3:167-71.
• 4. Bhargava P, Matthew P. Hair dye poisoning. J Assoc Physicians India 2007;55:871-2.
• 5. Beshir L, Kaballo B, Young D. Attempted suicide by ingestion of hair dye containing p-phenylenediamine: a case report. Ann Clin Biochem. 2017;54:507-10.
• 6. Anandhi D, Raju KP, Saya RP, Pandit VR. Difficult airway management in a case of hair dye poisoning. Int J Acad Med 2017;3:120-3.
• 7. Brown CA 3rd, Bair AE, Pallin DJ,Walls RM. Techniques, success,and adverse events of emergency department adult intubations. Ann Emerg. Med. 2015; 65: 363–70.
• 8. Begley, Jonathan & Butson, Ben & Kwa, Paul. (2017). The emergency surgical airway. Emergency Medicine Australasia. 29. 570-575. 10.1111/1742-6723.12850.
• 9. Hawkins ML, Shapiro MB, Cué JI, Wiggins SS. Emergency cricothyrotomy: a reassessment. The American Surgeon. 1995 Jan;61(1):52-55.