Clinical manifestations of systemic paraphenylene diamine intoxication.
BACKGROUND
To report clinical symptoms and outcome of systemic paraphenylene diamine (PPD) intoxication.


METHODS
Our study was retrospective. It was conducted over 6 yrs (1994-2000) in the medical intensive care unit (ICU) of a university hospital and it concerned 19 patients hospitalized for systemic PPD intoxication.


RESULTS
The mean age (+/- SD) was 27.9 +/- 16.8 yrs, the sex ratio was about 0.58 and the Simplified Acute Physiology Score (SAPS II) was 30 +/- 27. At admission, clinical symptoms were dominated by cervicofacial edema (79%), chocolate brown colored urine (74%), upper airway tract edema (68.4%), oliguria (36.8%), muscular edema (26.3%) and shock (26.3%). The biological results were dominated by rhabdomyolysis (100%), metabolic acidosis (100%), acute renal failure (ARF) (47.4%) and hyperkalemia (26.3%) (biological disturbances were more pronounced in patients with ARF). The therapies used were gastric lavage (100%), fluid infusion (100%), mechanical ventilation (84.2%), alcalinization (80%), corticosteroids (84.2%), vasopressors (26.3%) and renal replacement therapy (26.3%). The intoxication evolution was marked by the death of six patients (31.6%); five of them had developed ARF. The mechanical ventilation duration and the ICU stay were both more prolonged in patients who developed ARF.


CONCLUSIONS
Clinical manifestations of systemic PPD intoxication were associated with respiratory, muscular, renal and hemodynamic syndromes. ARF occurrence testifies to the severity of the intoxication.
Kallel
Hatem
H
Unit of Medical Resuscitation, CHU Habib Bourguiba, Sfax, Tunisia. kallelhat@yahoo.fr
Chelly
Hedi
H
Dammak
Hassen
H
Bahloul
Mabrouk
M
Ksibi
Hichem
H
Hamida
Chokri Ben
CB
Chaari
Adel
A
Rekik
Noureddine
N
De Broe
Marc E
ME
Bouaziz
Mounir
M
D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced* / Q000628:therapy; D000328:Adult; D004396:Coloring Agents / Q000506:poisoning*; D003402:Creatine Kinase / Q000097:blood; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005751:Gastric Lavage; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units; D016030:Kidney Transplantation; D008297:Male; D010655:Phenylenediamines / Q000506:poisoning*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012206:Rhabdomyolysis / Q000097:blood / Q000139:chemically induced* / Q000628:therapy; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014508:Urea / Q000097:blood
D004396:Coloring Agents; D005938:Glucocorticoids; D010655:Phenylenediamines; D014508:Urea; D003404:Creatinine; D003402:Creatine Kinase; C029728:4-phenylenediamine