31.12.40 Effects of Kalapather Poisoning on CPK, LDH, Blood Pressure and Heart Rate in Children

Original Article

 

Effects of Kalapather Poisoning

Effects of Kalapather Poisoning on CPK, LDH, Blood Pressure and Heart Rate in Children

Mohammad Sarwar, Nighat Sultana, Umar Waqar, Fareeha Kausar, Anila Jamil and Ghazala Shaffqat

ABSTRACT

Objective: To study the Effects of Kalapather Poisoning on CPK, LDH, Blood Pressure and Heart Rate in Children.

Study Design: Retrospective study

Place and Duration of Study: This study was conducted at the ICU children hospital Lahore during Jan 2014 to Dec 2019.

Materials and Methods: It was retrospective study. Sample size was 52. It was carried out in ICU of Children Hospital Lahore. SPSS version 25 was used for statistical analysis. Descriptive data and person correlation coefficient were measured. Informed written consent of parents was taken before start of study. The permission of Ethical Committee was considered before start of study and get published in Medical Journal.

Results: Mean values of CPK, LDH, heart rate, systolic blood pressure and diastolic blood pressure were much increased as compared to normal. CPK showed statistically significant and positive correlation with systolic and diastolic blood pressure.

Conclusion: Phenylenediamine PPD poisoning causes severe derangements in all systems of body in children. Blood pressure and heart rate increases along with CPK and LDH values yet if proper measure are taken timely then mortality may be reduced to minimum.

Key Words: CPK (creatine phosphokinase), LDH (Lactate Dehydrogenase), PPD (p-Phenylenediamine)

Citation of article: Sarwar M, Sultana N, Waqar U, Kausar F, Jamil A, Shaffqat G. Effects of Kalapather Poisoning on CPK, LDH, Blood Pressure and Heart Rate in Children. Med Forum 2020;31(12):171-173.

 

 

INTRODUCTION

Manner of poisoning in children is predominantly accidental1.Accidental poisoning is a major cause of accidental hurts that take place in children which may cause loss of life or damage to body leading to disability. More than 50% total cases which attend poisoning emergency centers belong to accidental poisoning in few countries2. Various studies carried out in different countries of the world clearly indicate that accidental poisoning is more in male gender as compared to females.

This is due to the fact that males are more agile than females. Children with less than six years of age more come across the accidental poisoning3. Different studies carried out to know the various reasons leading to accidental poisoning show that various elements like,

 

 

Department of Pediatric, Intensive care unit Children Hospital, Lahore.

 

 

Correspondence: Dr. Mohammad Sarwar, Assistant Professor Pediatric Intensive care unit Children Hospital, Lahore.

Contact No: 03334220546

Email: sarwardr2003@gmail.com

 

 

Received:    May, 2020

Accepted:    September, 2020

Printed:        December, 2020

 

 

how many are members of family, poverty, education, care of children and keeping the poisons and drugs separately are major facets influencing the occurrence of poisoning from things commonly used in houses like hair dye 4,5. Kala Pathar (black stone) is a low-cost and readily available hair dye in Pakistan. Its chemical ingredient PPD is a toxic and lethal substance when ingested6,7. After ingestion, PPD causes edema of face, neck, tongue, pharynx and larynx. Its poisoning also causes angioneurotic edema, rhabdomyolysis and renal failure8,9. Serum bilirubin, SGPT, SGOT, and serum alkaline phosphatase serum creatinine and CPK raised in its poisoning10,11.

MATERIALS AND METHODS

Sample Size:Fifty two patients of kala pather poisoning

Inclusion Criteria: Any children with history of poisoning of kalapather regardless of age, sex, socioeconomic condition and whose parents consented to take part in the study were included in the study.

Exclusion Criteria: Children with known heart disease were excluded from study.

This retrospective study was conducted on 52 patients of PPD (hair dye) poisoning, hospitalized in the Intensive Care Unit of children hospital Lahore during Jan 2014 to Dec 2019. Age, gender and body weight were recorded. History was taken. Heart rate, systolic and diastolic blood pressure was recorded. Physical examination was performed. Blood was taken for measuring serum levels of CPK and LDH. Intubation, tracheostomy was performed where needed. Ventilators were provided to save life when required.

Statistical Analysis: It was performed by SPSS version 25. Descriptive data of age, weight, sex, CPK, LDH, heart rate, systolic and diastolic blood pressure was measured. Graphs and table were made. Pearson correlation coefficient was measured between cardiac enzymes and blood pressure and heart rate.

RESULTS

Mean values of CPK, LDH, heart rate, systolic blood pressure and diastolic blood pressure were much increased as compared to normal. CPK showed statistically significant and positive correlation with systolic and diastolic blood pressure.

Table No. 1: Descriptive data of age, weight, sex, CPK, LDH, heart rate, systolic and diastolic blood pressure

Descriptive Statistics

 

N

Minimum

Maximum

Mean

Std. Deviation

Age

52

2.00

8.00

4.7196

1.57440

CPK

52

243.00

9175.00

1452.4231

2153.52173

LDH

52

432.00

8671.00

1296.8077

1586.30653

Heart_Rate

52

121.00

190.00

144.8462

15.68987

BP_systolic

52

55.00

123.00

85.4231

17.24148

BP_diastolic

52

38.00

90.00

55.0000

9.57939

Table No. 2: Correlation between LDH and heart rate, systolic blood pressure and diastolic blood pressure LDH

 

 Pearson correlation coefficient value

Value of p

Heart rate

0.294

0.035

Systolic blood pressure

0.07

0.602

Diastolic blood pressure

-0.03

0.834

Table No. 3: Correlation between CPK and heart rate, systolic blood pressure and diastolic blood pressure CPK

 

 Pearson correlation coefficient value

Value of p

Heart rate

0.260

0.063

Systolic blood pressure

0.561

0.000

Diastolic blood pressure

0.550

0.000

Table No. 4: Correlation between CPK and LDH

Correlations

 

LDH

CPK

LDH

Pearson Correlation

1

.590**

Sig. (2-tailed)

 

.000

N

52

52

CPK

Pearson Correlation

.590**

1

Sig. (2-tailed)

.000

 

N

52

52

DISCUSSION

In this study effects of kalapather poisoning on CPK, LDH, blood pressure and heart rate were studied. Correlation between all these variables was done on SPSS 25 version. 34 needed inotropes and only one patient developed arrhythmia which led to his death. Mortality was 1.9% only. Minimum heart rate noted was 121/min and maximum heart rate was 190/min. Minimum systolic blood pressure was 55 and maximum was 123 mm of Hg. Similarly minimum diastolic blood pressure was   38 and maximum was 90 mm of Hg.

There was no statistically significant correlation between CPK and heart rate. But there was statistically positive and significant correlation between CPK and systolic as well as diastolic blood pressure. In case of LDH and heart rate there was weak correlation with value of r equal to 0.294. LDH did not give any significant correlation with systolic as well as diastolic blood pressure. In a study carried out in Nawab Shah12 it was found that mean value of CPK was 28.43 mg/dl while in this study minimum value of CPK was 243 mg/dl and maximum value was 9175 mg/dl.37.63 U/L was maximum value of CPK in a study in India13.But those for adults and this study was carried out in children. In another study it was found that tracheostomy was essential to save life of patient14.In another study in South India it was found that 92% patients had elevated levels of CPK15.In a study values of CPK and LDH were 3700 and 1854 U respectfully16.32.84 IU/L was measured as a mean value in a study in Karachi17.In this study values of CPK and LDH were drastically elevated yet mortality was very low. Only one death took place that developed arrhythmias.

CONCLUSION

Phenylenediamine PPD poisoning causes severe derangements in all systems of body in children. Blood pressure and heart rate increases along with CPK and LDH values yet if proper measure are taken timely then mortality may be reduced to minimum.

Author’s Contribution:

Concept & Design of Study:

Mohammad Sarwar, Nighat Sultana

Drafting:

Mohammad Sarwar, Nighat Sultana, Umar Waqar

Data Analysis:

Fareeha Kausar, Anila Jamil

Revisiting Critically:

Ghazala Shaffqat

Final Approval of version:

Mohammad Sarwar, Nighat Sultana

Conflict of Interest: The study has no conflict of interest to declare by any author.

REFERENCES

1.      Lee J, Fan NC, Yao TC, Hsia SH, Lee EP, Huang JL, Wu HP. Clinical spectrum of acute poisoning in children admitted to the pediatric emergency department. Pediatr Neonatol 2019;60(1):59-67.

2.      Dayasiri MB, Jayamanne SF, Jayasinghe CY. Patterns and outcome of acute poisoning among children in rural Sri Lanka. BMC Pediatr 2018; 18(1):274.

3.      Polasa R, Sirangi M, Kagitapu S. Childhood accidental poisoning in South India. J Dent Med Sci 2016;15:77-80.

4.      Khan NU, Khan UR, Feroze A, Khan SA, Ali N, Ejaz K, et al. Trends of acute poisoning: 22 years experience from a tertiary care hospital in Karachi, Pakistan. J Pak Med Assoc 2016;66(10):1237.

5.      Manzar N, Saad SMA, Manzar B, et al. The study of etiological and demographic characteristics of acute household accidental poisoning in children - a consecutive case series study from Pakistan. BMC Pediatr 2010;10:28.

6.      Khan MA, Akram S, Shah HB, Hamdani SA, Khan M. Epidemic of kala pathar (paraphenylene diamine) poisoning: an emerging threat in southern Punjab. J Coll Physicians Surg Pak 2018;28(1):
44-7.

7.      Tipu HN, Bashir MM, Iqbal W. Determination of specificity and pattern of antinuclear antibodies (ANA) in systemic rheumatic disease patients positive for ANA testing. J Coll Physicians and Surgeons Pak 2018;28(1):40-3.

8.      Hanumanthayya K, Balasubrahmanyam G, Mohan M, Mohan S, Nikhil N. Hair Coloring–Hair Dyeing. RGUHS J Med Sci 2018;8(1):13-7.

9.      Sukakul T, Limphoka P, Boonchai W. Hair dye allergy and hair dyes in Thai market: A literature review and recommendations. Thai J Dermatol 2018;34(4):245-65.

10.  Khaskheli MS, Shaikh S, Meraj M, Raza H, Aslam I. Paraphenylenediamine poisoning: Clinical features, complications and outcome in a tertiary care institute. Anaesthesia, Pain Intensive Care 2019:343-7.

11.  Iqbal J, Hussain M, Hussain A, Ghafoor MB. Paraphylene diamine/kalapathar poisoning; to study the demo graphic profile, clinical manifestations and outcome of paraphylene diamine/kala pathar poisoning at sheikh zayed Hospital Rahim Yar Khan. Professional Med J 2019;26(5).

12.  Khuhro BA, Khaskheli MS, Shaikh AA. Paraphenylene diamine poisoning: our   experience at PMC Hospital Nawabshah. Anaesthesia Pain Intensive Care 2019:243-6.

13.  Kondle R, Pathapati RM, Saginela SK, Malliboina S, Makineedi VP. Clinical profile and Outcomes of hair dye poisoning in a teaching hospital in Nellore. ISRN Emergency Med 2012;2012.

14.  Abdelraheem M, Ali ET, Hussien R, Zijlstra E. Paraphenylene diamine hair dye poisoning in anadolescent. Toxicology and Industrial Health 2011;27(10):911-3.

15.  Chrispal A, Begum A, Ramya I, Zachariah A. Hair dye poisoning–an emerging problem in thetropics: an experience from a tertiary care hospital in South India. Tropical doctor 2010;40(2):100-3.

16.  Garg SK, Tiwari R, Ahlawat A. Hair dye poisoning: An unusual encounter. Indian journal of criticalcare medicine: peer-reviewed, official publication of Ind Soc Critical Care Med 2014; 18(6):402.

17.  Sultan MO, Khan MI, Ali R, Farooque U, Hassan SA, Karimi S, et al. Paraphenylenediamine (Kala pathar) poisoning at the National Poison Control Center in Karachi: a prospective study. Cureus 2020;2(5).