Sayed Aml Ahmed, Abdelrahman Abdelrahman Hamdy, Sayed Zein Elabdeen Ahmed, Abdelhameid Marwa Ahmed
Internal Medicine Department, Faculty of Medicine, Aswan University, Aswan, Egypt.
Internal Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
Int J Emerg Med. 2024 Jan 2;17(1):2. doi: 10.1186/s12245-023-00577-y.
Black rock, Kala Pathar or ParaPhenyleneDiamine (PPD), is an aromatic amine widely used as a hair dye ingredient and is also used in textile industries. However, when ingested, PPD is highly toxic resulting in angioneurotic edema, rhabdomyolysis, acute kidney injury, toxic hepatitis, and myocarditis with a high mortality rate. This study aimed to evaluate the incidence and outcome of laryngeal edema and rhabdomyolysis after ingestion of PPD.
The current research was a cross-sectional study that was conducted at Aswan University Hospital, Aswan, Egypt, from December 2021 to December 2022. It consisted of 100 people who attempted suicide by ingesting black rock. All patients underwent general examinations and investigations, including complete blood count, urea, creatinine, creatine phospho kinase, alanine aminotransferase, aspartate aminotransferase, calcium, uric acid, phosphorus, urine analysis, and electrocardiography.
The current study consisted of 15 males and 85 females; the most common presentation was stridor (88%) followed by muscle weakness (50%). Twelve percent of patients with stridor required tracheostomy while 14% required tracheal intubation. Regarding the complications of PPD ingestion, the incidence of hepatic injury was (97%) and acute kidney injury (14%) five of them required hemodialysis, with a mortality rate of 13%. Cardiac arrhythmias were noticed in the form of sinus tachycardia (24%), sinus bradycardia (3%), atrial fibrillation (5%), ventricular fibrillation (6%), and ventricular tachycardia (7%). Our study found a significant positive correlation between creatine phosphokinase, muscle weakness, and acute kidney injury (P = 0.005). Whereas a significant positive correlation was noted between stridor, hospital stay, and mortality rate (P = 0.000), (P = 0.003), respectively. Moreover, a significant positive correlation was found between tracheotomy, mortality rate, and hospital stay (P = 0.000).
PDD toxicity is more frequent in younger females. The intoxication from the black rock is increasingly used in suicide attempts and vital organs are usually affected especially the kidney, liver, and heart causing morbidity and mortality.
黑岩、卡拉帕塔尔或对苯二胺（PPD）是一种芳香胺，广泛用作染发剂成分，也用于纺织工业。然而，PPD摄入后具有高毒性，可导致血管神经性水肿、横纹肌溶解、急性肾损伤、中毒性肝炎和心肌炎，死亡率很高。本研究旨在评估PPD摄入后喉水肿和横纹肌溶解的发生率及转归。
本研究为横断面研究，于2021年12月至2022年12月在埃及阿斯旺的阿斯旺大学医院进行。研究对象为100例因摄入黑岩而企图自杀的患者。所有患者均接受了全面检查和调查，包括血常规、尿素、肌酐、肌酸磷酸激酶、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、钙、尿酸、磷、尿液分析和心电图检查。
本研究包括15例男性和85例女性；最常见的表现是喘鸣（88%），其次是肌肉无力（50%）。12%有喘鸣的患者需要气管切开术，14%需要气管插管。关于PPD摄入的并发症，肝损伤发生率为97%，急性肾损伤发生率为14%，其中5例需要血液透析，死亡率为13%。观察到的心律失常形式包括窦性心动过速（24%）、窦性心动过缓（3%）、心房颤动（5%）、心室颤动（6%）和室性心动过速（7%）。我们的研究发现肌酸磷酸激酶、肌肉无力与急性肾损伤之间存在显著正相关（P = 0.005）。而喘鸣、住院时间和死亡率之间分别存在显著正相关（P = 0.000），（P = 0.003）。此外，气管切开术、死亡率和住院时间之间存在显著正相关（P = 0.000）。
PDD中毒在年轻女性中更为常见。黑岩中毒越来越多地被用于自杀企图，重要器官通常会受到影响，尤其是肾脏、肝脏和心脏，从而导致发病和死亡。
