Myocardial damage in hair dye poisoning--an uncommon presentation.

A 22-year-old female presented to us after consuming hair dye with features of angio-neurotic edema, asphyxia and irregular pulse. Serial ECGs revealed presence of ST segment elevation and T wave inversion in anterior chest leads. Strongly positive c-troponin-T test further confirmed the myocardial damage. This is a rare manifestation of para-phenylene diamine poisoning mentioned in literature. Patient also had elevated liver enzymes and oliguria.

Outcome of sixty four cases of ethylene dibromide ingestion treated in tertiary care hospital.

BACKGROUND AND AIMS: In view of high incidence and mortality due to ethylene dibromide poisoning, a prospective study was planned to assess demographic, toxicological, clinical profile and outcome. MATERIAL AND METHODS: Prospectively collected data of sixty four patients with ethylene dibromide poisoning were reviewed. All the patients were from Gwalior and neighbouring districts. RESULTS: Majority were males in the age group 21-30 years. Out of sixty-four cases 26 patients (40.6%) survived and 38 patients (59.4%) expired. Nausea vomiting and pain abdomen were most common symptoms at presentation. Diarrhoea, drowsiness, palpitations and oliguria were other features. Pulse rate was normal (< 100) in 22 (84.6%) survived patients whereas it was > 100 in 24 (63.1%) of expired patients at the time of admission (p value = 0.0004199). Half ampoule (1.5ml.) of ethylene dibromide was sufficient as fatal dose. Mortality was 20% and 46.15% with half and one ampoule respectively. Best outcome was when the patient presented to the hospital within six hours. Death occurred anywhere between twelve hours and five days. Gastrointestinal toxicity was predominant at presentation. Nausea, vomiting and abdominal pain was present in all the patients. Nephrotoxicity 32 (50%), hepatotoxicity 28 (43.8%), cardiotoxicity 28 (43.8%), central nervous system 8 (12.5%) toxicity and hypoglycemia 24 (37.5%) were also observed. CONCLUSION: Ethylene dibromide is highly toxic. Patients who consumed half to one ampoule usually survived with supportive care provided they presented to the hospital within six hours. Pulse rate more than 100 at presentation was a poor prognostic factor. Patients with normal pulse and blood pressure at admission had better prognosis.