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Abstract
Background: Paraphenylenediamine (PPD), commonly known as Kala Pathar, is a widely available hair dye ingredient that has emerged as a major cause of intentional poisoning in South Asia.
Objective: To evaluate the clinical profile, complications, management strategies, and outcomes of patients presenting with confirmed Paraphenylenediamine poisoning and receiving supportive care at a tertiary care hospital.
Methodology: This prospective single-arm cohort study was conducted at the National Poisoning Control Centre (NPCC), Jinnah Postgraduate Medical Centre (JPMC), Karachi, from April 2024 to September 2024. A total of 100 consecutive patients with confirmed Kala Pathar ingestion were enrolled. Data regarding demographics, mode and route of exposure, clinical manifestations, biochemical parameters, hospital stay, ICU requirement, and outcomes were recorded.
Results: Out of 100 patients, 93% had suicidal intent, and 98% ingested the compound orally. Cervicofacial swelling (97%), dysphagia (85%), and dyspnea (71%) were the most common presenting features. Complications included rhabdomyolysis (62%), renal failure (28%), hepatitis (25%), and hyperkalemia (29%). The mean hospital stay was 4.0 ± 3.5 days among survivors versus 5.9 ± 3.5 days among those who expired. Overall mortality was 18%, with most deaths occurring within the first two weeks of admission. The Kaplan–Meier analysis showed a mean survival time of 10.5 days (95% CI: 9.2–11.7).
Conclusion: Kala Pathar poisoning remains a critical medical emergency characterized by rapid systemic deterioration. Early airway management, fluid resuscitation, and renal support markedly improve survival. Mortality is primarily associated with delayed presentation and severe multi-organ involvement.