Creatine phosphokinase, lactate dehydrogenase and total leukocyte count during treatment for oral hair dye poisoning

Introduction: Paraphynylenediamine (PPD) in hair dye causes angioneurotic edema leading to acute respiratory distress, rhabdomyolysis, i.e. necrosis of skeletal muscle resulting in acute renal failure and liver injury upon ingestion. We studied the time course of treatment on organ damage markers such as plasma Creatine phosphokinase (CPK), Lactate dehydrogenase (LDH) and Total leukocyte count (TLC) of these patients till discharge. Materials and methods: We reviewed the case records of 10 Patients of suicidal hair dye poisoning. Data was collected in pre-specified data collection forms regarding WBC count, CPK levels, age, gender, time to index admission, ventilator support, the volume of ingestion and outcome. We followed the values of CPK and TLC of these patients till discharge. Results: The average age was 25.8±10.5, the mean volume of consumption of hair die was 102.5±17.5, and time to reach emergency room was 7.6±3.2 hours. On arrival, all patients were intubated and received gastric lavage, antihistamines, parenteral steroids, and sodium bicarbonate. Duration of ventilator support was 2.9±0.7 days and length of hospital stay was 10.1±2.7 days. At admission, CPK, TLC, and LDH were elevated, during hospital stay values CPK, LDH and TLC gradually decreased by day-5 after that they showed a marginal increase by day-7. Conclusion: We observed significantly elevated levels of CPK, LDH and TLC at index admission after oral ingestion of hair dye suggesting muscle, hepatic and hematological injury. The rate of decline of these values (recovery) is parallel.