PREDICTORS OF POOR OUTCOME IN PARAPHENYLENE DIAMINE (‘BLACK STONE’) POISONING: A RETROSPECTIVE COHORT FROM NAWABSHAH, PAKISTAN
Main Article Content
Keywords
Paraphenylene diamine, black stone, hair dye poisoning, predictors, outcomes, Pakistan
Abstract
Paraphenylene diamine, commonly known as “black stone”, is a readily available hair-dye chemical widely used for intentional self-poisoning in South Asia. Despite its high fatality rate, evidence on predictors of poor outcomes remains limited. This study aimed to identify demographic, clinical, and laboratory factors associated with adverse outcomes in patients presenting with black stone poisoning.
Study design: Retrospective cohort study
Place of study: This study was conducted at People’s University of Medical & Heath Sciences for women Nawabshah
Duration: June 2023 to December 2023
Methods: Medical records of 240 patients were reviewed for demographics, intent of ingestion, clinical presentation, laboratory findings, and outcomes. Outcomes were defined as discharge, leaving against medical advice, or death. Data were analyzed using descriptive statistics, bivariate comparisons, and regression analysis, with significance set at p<0.05.
Results: The cohort comprised 240 patients, predominantly young adults (mean age 24 years) with a female majority (75%). Most cases followed suicidal ingestion (nearly 90%). The average time from ingestion to hospital arrival was under six hours. Laboratory findings showed mean hemoglobin of 12.7 g/dL, total leukocyte count around 10.5 ×10³/µL, and serum glucose of 259 mg/dL. Neurological and cardiovascular manifestations were strongly associated with adverse outcomes, whereas other laboratory variables showed limited predictive value. Mortality was most evident in patients who had ingested larger amounts or presented with severe systemic involvement.
Conclusions: Black stone poisoning continues to affect young women disproportionately in our setting, largely due to suicidal intent. Neurological and cardiovascular complications emerged as early red flags for poor prognosis. Prompt recognition and aggressive management of these features are essential to improve survival. Preventive strategies, including community awareness and restrictions on the availability of paraphenylene diamine, are urgently needed.
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Khalida
Post Graduate Trainee Department of Medicine, People’s University of Medical & Heath Sciences for women Nawabshah Pakistan. email: dr.khalida.32@gmail.com (Corresponding author)
Amina
Medical officer Medical Unit 2, People’s University of Medical & Heath Sciences for women Nawabshah Pakistan. email: aminaabbasi30@gmail.com
Faiza Parveen
House officer Department of Medicine, Ghulam Muhammad Mahar Medical College Sukkur Pakistan. email: faizakh238@gmail.com
Sumera
Post Graduate Trainee Department of Medicine, People’s University of Medical & Heath Sciences for women Nawabshah Pakistan. email: sumerajarwar@gmail.com
Qurat ul ain
Post Graduate Trainee Medical Unit 1, People’s University of Medical & Heath Sciences for women Nawabshah Pakistan. email: Qurat.bullo@gmail.com
Zakir
Post Graduate Trainee Department of Internal Medicine, People’s University of Medical & Heath Sciences for women Nawabshah Pakistan. email: znbhatti1997@gmail.com
