as the global suicide rate increases by 60% in 50 years in the underdeveloped and developing countries , paraphenylenediamine ( ppd ) poisoning is emerging as an important etiological factor reported from india .
ppd ingestion is a very common form of poisoning in india as this compound is a component of hair dyes and is easily available .
it is brown or black colored solid substance , easily soluble in hydrogen peroxide and not in water .
it is a good hydrogen donor and metabolized by electron oxidation to an active radical by cytochrome p450 peroxidase to form a reactive compound called benzoquinone diamine .
this can be further oxidized to a trimer known as brandowaski 's base , a well known compound , reported to cause anaphylaxis and mutation .
it is traditionally used for dyeing palms and soles along with henna and to dye the hairs .
ingestion of ppd causes rapid development of edema of the face , neck , pharynx , tongue and larynx initially and rhabdomyolysis later
. finally , an acute renal failure supervenes as renal tubular necrosis occurs due the deposits of the toxic metabolites of ppd .
a 24-year - old young man who had ingested ppd pellets ( an exact amount could not be ascertained ) with suicidal intention .
he developed generalized itching and intermittent lacrimation for a few days and was treated symptomatically by a nearby medical practitioner from whom he concealed the history of consumption of ppd pellets .
he presented after 6 days with complaints of pain and stiffness of both lower limbs and passage of chocolate colored urine followed by anuria .
his blood urea and serum creatinine were 210 mg / dl and 12.4 mg / dl , respectively .
he was managed symptomatically with diuretics , phosphate binders , sodium bicarbonate , oral calcium and alkalization of urine . in view of his persistent oliguria and deranged metabolic parameters ,
myocarditis , myocardial rhabdomyolysis and shock have also been described in ppd poisoning . though the cervicofacial edema is also a common manifestation , it was not a prominent clinical feature in this case .
the alteration in the prominent clinical features may be due to the symptomatic management in the initial stages .
the major cause of mortality is respiratory distress due to edema , complications related to myocarditis and renal .
the cause of acute tubular necrosis in ppd poisoning , independent of rhabdomyolysis is due to concentration of ppd in the renal tubules .
this occurs due to aromatic structure of ppd , which makes it readily absorbable and concentrated in the tubules .
gastric lavage with 2% sodium bicarbonate is also effective . due to low molecular weight and hydrophilic nature
an acute renal failure is managed with adequate input and output charting , treating metabolic complications due to renal failure like hyperkalemia , hypocalcemia , hyperphosphatemia and metabolic acidosis by hemodialysis .
renal biopsy may be done when there is undue delay in recovery of renal function .
apart from an intentional or accidental excessive exposure to ppd , which results in above manifestations , routine use of this compound on regular basis for a long time can also lead to toxic effects .
association between personal hair dye use and non - hodgkin 's lymphoma , multiple myeloma , leukemia and other bladder cancer have been reported but have not been consistently observed .
however , the united states environmental protection agency has not classified ppd as a carcinogen . therefore , no warnings of toxicity are printed on boxes of hair dye .
but , in view of an easy availability and potential toxicity , awareness about the toxic effects of this compound and adequate warnings for the users may be useful .
 the commonest constituent of all hair dyes is paraphenylene diamine ( ppd ) . 
 hair dye poisoning is emerging as one of the emerging causes of intentional self - poisoning to commit suicide . in this article 
 , we report a case of ppd poisoning and the importance of clinical of hair dye poisoning . 
 the lack of specific diagnostic tests , a specific antidote for paraphenylene diamine poisoning and the importance of early supportive treatment modalities are also discussed . 
Introduction
Case Report
Discussion