KALA PATHAR - Nishtar Medical Journal

NMJ 2010; 2(4):111-115KALA PATHAR (PARAPHENLENE DIAMIN) INTOXICATIONemergency department of Nishtar HospitalMultan.Their clinical and laboratory data wasextracted from the specified charts.Demographic details (age, sex, social class,domestic conflicts, location, mode ofintoxication, latent period of symptoms onset),clinical presentation, laboratory findings,treatment details and outcomes were identifiedand analyzed using SPSS 12 version.Therapeutic measures included gastric lavage,anti-histamines, parenteral steroids, inhaledsalbutamol, broad spectrum antibiotics,intravenous fluids and alkalinediuresis.Ventilator / haemodynamic support andhaemodialysiswere performed where appropriateclinical and laboratory indicationsexisted.Tracheostomy was performed for severelingual, sublingual, submandibular edema withdyspnea and stridor.After death of the first patient, case and topicwas discussed in the grand meeting of MedicalUnit-II. Management protocol with specificobjective procedures (SOP) was decided, tohandle such patients with this intoxication, infuture. Details are described as follows:1. MAINTAIN AIRWAY: Tracheostomy,Assessment of ABGs2. BREATHING: Oxygen + Assistedventilation3. CIRCULATION: Intravenous line (widebore) and intravenous 0.9% normal saline4. ASSESMENT OF PATIENT’S FLUIDSTATUS AND CORRECTION OFDEFICIT BY: Pulse rate, JVP, BP (supineand standing/sitting), urine output(catheterize the patient)5. GASTRIC LAVAGE : Withactivatedcharcoal 2grams 6 hourly6. FOR LARYNGEAL EDEMA ± ARDS(Ifdevelops) :InjectionHYDROCORTISONEHEMISUCCINATE 500mg 6Times/day +InjectionCHLORPHENIRAMINEMALEATE 4mg 8hourly7. FORCED DIURESIS: 5-6 liter ofintravenous fluid + 75 mmol SODIUMBICARBONATE + InjectionFUROSEMIDE 20mg 8hourly + Injection20% MANNITOL 250cc (If Patientstilloliguric)8. FOR HYPERKALEMIA: InjectionCALCIUM GLUCONATE intravenous 8hourly and SALBUTAMOLNEBULIZATION 3 hourly9. CARDIAC SUPPORT(Ifhypotensionpersistsdespite adequate fluidintake): Injection DOPAMINEINFUSION@ 6-8 ug/Kg/body weight/min(to maintainsystolicblood pressure> 90)10. CONSULT NEPHROLOGIST:Ifpatientdevelops Acute Renal Failure andproceed for haemodialysis11. DAILY INVESTIGATIONS: Haemoglobin,Urea, Creatinine, Sodium, Potassium,Calcium, Phosphorus, Liver function tests,Creatinine phosphokinase, Blood sugar,Serum bicarbonate, Arterial blood gases,Prothrombin time/Activated partialthromboplastin time and Electrocardiogram12. COUNSELLING OF PATIENT’SATTENDANTSRESULTS:Five patients were studied admitted fromSeptember 2011 to February 2012. All werefemales of young age (mean age = 25.5 ± 4.56years) from low social group. Suicidal reasoningwas identified in 60% while accidental andhomicidal in 20% each. Social conflicts formedthe basis of 80% of intoxications [Table-I].Manifestations of local injury (pain in throat,oral erythema, cervicofacial edema, dysphagia,Nishtar Medical Journal • Vol 2, No 4• October – December 2010 112