Background: Paraphenylenediamine (PPD), also known as Kaala pathar, has become an emerging and life threating source of poisoning in Pakistan as well as in many other Asian and African nations. The aim of this study is to recognize the etiological factors, clinical features and outcomes of patients with PPD poisoning. Methodology: This observational prospective analytic study included 32 patients who presented in ICU of Nishtar Hospital, Multan. Patients were first managed conservatively by IV fluids, diuretics, antihistamines and steroids; tracheal intubation or tracheostomy was performed only if needed. Univariate analysis was used to determine the independent variables of mortality after PPD poisoning and odds ratios were calculated. Results: Cervicofacial edema, oral erythema and sore throat were most common clinical presentation of patients at the time of admission in ICU, with incidence rates of 93.8%, 81.3% and 75.0%, respectively. Acute renal failure occurred in 34.4% patients and acute hepatitis in 18.75% patients. The independent predictors of mortality after PPD poisoning were: male gender (odds ratio 16.62), dysphagia (odds ratio 9.92), hyperkalemia (odds ratio 84.0), development of cardiogenic shock (odds ratio 36.75), acute renal failure (odds ratio 16.62) and acute hepatitis (odds ratio 27.50). Tracheostomy was required in all 30 (93.7%), and 13 (40.6%) patients required mechanical ventilation support. In-hospital mortality was 9 (28.1%). Mean stay of patients in ICU was 3.47 [+ or -] 2.04 days Conclusion: Paraphenylenediamine (Kaala Pathar) poisoning has become one of the major means of suicide attempts with very high mortality rate. Male gender, dysphagia at the time of presentation, hyperkalemia, cardiogenic shock, acute renal failure and acute hepatitis are the independent predictors of mortality after PPD poisoning. Key words: Paraphenylene diamine; Poisoning; Facial edema; Tracheostomy: Mortality
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