A clinical study and laboratory evaluation of the cardiac and hepatic toxic effects of paraphenylenediamine

Abstract

Introduction

Paraphenylenediamine is the main component in many commercial hair dyes, and can produce severe local and systemic toxicity reactions after acute ingestion or dermal absorption. The aim of this study was to assess the factors contributing to morbidity and mortality in cases of acute paraphenylenediamine poisoning, with a focus on evaluating the resultant hepatic and cardiac toxicity.

Methods

This observational study was conducted on patients with acute paraphenylenediamine poisoning presenting to Sohag University Hospitals, and included a retrospective part from February 2021 to January 2022 and a prospective part from February 2022 to July 2022. Clinical data were extracted and receiver operating characteristic curves created to identify prognostic markers.

Results

Among 50 eligible patients 39 (78 percent) recovered, and 11 (22 percent) died or had permanent complications. Angioedema and anuria were the most frequent features in complicated cases. By receiver operating characteristic analysis, either an increase in aspartate aminotransferase activity greater than 644 IU/L or alanine aminotransferase activity greater than 798 IU/L, a time delay to presentation of greater than 4.5 hours, and a pH of less than 7.32 were associated with a significant increase in morbidity and mortality. While cardiac enzyme activities, and concentrations of blood urea nitrogen and creatinine increased in most cases, they were not associated with mortality.

Discussion

Management of patients with paraphenylenediamine poisoning is mainly supportive, as there is no specific antidote. Respiratory failure and kidney failure are the most life threatening complications. Hepatoxicity and cardiotoxicity also occur. The ability to predict the events can help guide patient disposition and care.

Conclusion

Elevated liver enzyme activities, increased time delay to admission, decreased pH, and the presence of angioedema and anuria can be used as predictors of morbidity and mortality in patients with acute paraphenylenediamine poisoning.

Keywords:

• Acute poisoning
• paraphenylenediamine
• cardiac toxicity
• hepatic toxicity
• prognostic markers

Acknowledgment

The authors would like to thank Dr. Reda M. Elsayed, the assistant professor of Forensic and Clinical Toxicology, Faculty of Medicine, Sohag University, in Egypt, for her assistance with the manuscript preparation and her valuable comments.

Author contributions

Mai M. Abd El-Kader wrote the introduction and discussion and revised the data. Palqees A. Mohammed wrote the abstract and methodology, participated in the discussion, and revised the data. Mohammed A. Abd El Ati wrote the conclusion and recommendations and revised the manuscript. Meray Medhat Shokry Zaghary: formed the research idea, collected the data, organized them in an Excel sheet, analyzed them, expressed them in tables and Figures, and revised the whole data.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

Data are available upon reasonable request from the corresponding author.

Additional information

Funding

The authors reported there is no funding associated with the work featured in this article.