Acute renal failure owing to paraphenylene diamine hair dye poisoning in Sudanese children

Introduction: Paraphenylene diamine (PPD) has traditionally been used as a dark-coloured hair dye. In Sudan, it is used by women to colour their hair and as a body dye when added to henna (Lawasonia alba). Accidental or deliberate ingestion causes severe systemic toxicity. Although a wide variety of complications has been described, there are few reports in children. Aim: To describe the clinical features, management and outcome of PPD intoxication in Sudanese children Methods: Data for a 3-year period (2006-2008) were extracted from the medical records of the Paediatric Nephrology Unit, Soba University Hospital. Information included the circumstances of poisoning, gender, age distribution, clinical presentation, biochemical findings and outcome. Results: Over the 3-year period, 17 children (16 female) were admitted to the Paediatric Nephrology Unit with PPD intoxication. Mean age was 13.8 yrs (range 2-18). Thirteen (76.4%) had attempted suicide, three (17.6%) were poisoned as a result of attempted murder and one poisoning (5.8%) was accidental. Eight children (47%) required tracheostomy for severe angioneurotic oedema. Of 12 (71%) who developed acute renal failure (ARF), nine required dialysis and three were managed conservatively. Two children (12%) died and the other 15 recovered with normal renal function. Conclusion: PPD intoxication is a life-threatening condition with significant morbidity and mortality in children. Clinical manifestations and outcome are similar to those in adults. Mortality can be reduced by early recognition, prompt referral and aggressive supportive treatment.