Mendonca Satish, Barki Satish, Mishra Mayank, Kumar R S V, Gupta Devika, Gupta Pooja
Department of Nephrology, Armed Forces Medical College and Command Hospital Southern Command, Pune, India.
Saudi J Kidney Dis Transpl. 2015 Sep;26(5):980-2. doi: 10.4103/1319-2442.164583.
We present a young lady who consumed hair dye, which contained paraphenylene diamine (PPD), as a means of deliberate self-harm. This resulted in severe angio-neurotic edema for which she had to be ventilated, and thereafter developed rhabdomyolysis leading to acute kidney injury (AKI). The unusual aspect was that the patient continued to have flaccid quadriparesis and inability to regain kidney function. Renal biopsy performed 10 weeks after the dye consumption revealed severe acute tubular necrosis with myoglobin pigment casts. This suggests that PPD has a long-term effect leading to ongoing myoglobinuria, causing flaccid paralysis to persist and preventing the recovery of AKI. In such instances, timely treatment to prevent AKI in the form alkalinization of urine should be initiated promptly. Secondly, because PPD is a nondialyzable toxin, and its long-term effect necessitates its speedy removal, hemoperfusion might be helpful and is worth considering.
我们报告一位年轻女性，她吞食了含有对苯二胺（PPD）的染发剂，以此作为一种蓄意自残的方式。这导致了严重的血管神经性水肿，为此她需要进行通气治疗，此后又发展为横纹肌溶解症，进而导致急性肾损伤（AKI）。不同寻常的是，该患者持续存在弛缓性四肢瘫，且肾功能无法恢复。在吞食染发剂10周后进行的肾活检显示严重的急性肾小管坏死，并伴有肌红蛋白色素管型。这表明PPD具有长期影响，导致持续性肌红蛋白尿，致使弛缓性麻痹持续存在，并阻碍急性肾损伤的恢复。在这种情况下，应及时开始以尿液碱化形式预防急性肾损伤的治疗。其次，由于PPD是一种不可透析的毒素，且其长期影响需要迅速清除，血液灌流可能会有帮助，值得考虑。
