Super-vasmol hair dye poisoning is a major cause of suicidal poisoning in India, as its main toxic ingredient, paraphenylene diamine (PPD), is cheap and readily available. PPD poisoning can cause multi-organ dysfunction and failure through two phases - an initial acute presentation with angioedema and airway obstruction within 4-6 hours, followed by a subacute phase involving rhabdomyolysis, acute renal failure, hepatitis, and metabolic acidosis. Aggressive management is focused on airway protection, steroids to reduce angioedema, fluid resuscitation to prevent renal failure, and dialysis as needed.

2.  Super-vasmol poisoning is emerging as a
major cause of suicidal poisoning in India…as
it is a cheap ,freely available hair dye
 It contains potential toxins like PPD which can
result in multiorgan dysfunction

3. The main important constituent is
 PPD(paraphenylene diamine)- <4%
Other constituents are
 Propylene glycol
 Resorcinol
 EDTA Sodium
 Ceto stearyl alcohol
 Sodium lauryl sulphate
 Liquid paraffin
 Preservatives and water

4.  PPD(paraphenylene diamine):it is the major toxin
among all constituents
 PPD metabolised by CYP450 to form
BRANDOWASKI’S BASE
It is an anaphylactic,highly toxic
and strongly mutagenic
The lethal dose is 7 to 10 gms..
But 3gms is sufficient to cause systemic
complications

5. It produces both local and systemic effects.
Systemic effects occurs in two phases:
 Phase 1
Acute presentation (4-6hrs):cervicofacial
edema,airway obstruction,gastritis and severe
vomiting.
 Phase 2
Subacute presentation withARF,rhabdomyolysis
and hemolysis.
Hepatitis.
Hyperkelemia,hypocalcemia,hyperphosphatemia.
Severe metabolic acidosis

6.  Even 5 to 10 ml super vasmol can cause
laryngeal edema due to direct toxic effect of
PPD on membranes..
 No specific antidote available for PPD,hence
management is only symptomatic &
supportive .
 Development of pneumothorax is reported
following laryngeal edema
Intense inspiratory effort secondary to
laryngeal edema leading to overdistension of
alveoli.

7. Local effects of PPD:
• Skin iritation
• Contact dermatitis
• Chemosis,lacrimation and exopthalmous
• Permanent blindness

8.  Chronic hair dye use is associated with non-
Hodgkin’s lymphoma,multiple myeloma,acute
leukemia,and bladder cancer

9.  Resorcinol-
it causes methemoglobinemia and
renal toxicity
 EDTA sodium-
it causes hypocalcemia
 Propylene glycol-
it is ass. with hyperosmolarity, CNS depression,
arrythmias
it is nephotoxic and results in high anion
gap metabolic acidosis and acute renal failure.

10.  In addition to these a few hair dyes also
contain Lead acetate and Bismuth sulphate
which causes CKD and Acute interstitial
nephritis respectively..

11. 1.Angioedema or Cervicofacial edema:
 Early manifestation (within 4-6 hours) include
respiratory distress due to swelling of upper
airway and angioedema
 Angioedema is immunologically
mediated,anatomically limited,nonpitting edema.
 It is an abrupt swelling of the dermis and
subcutis

12.  STAGING OF ANGIOEDEMA:
This is to predict airway risk at presentation.
Stage 1 - Facial and lip edema
Stage 2 - soft palate edema
Stage 3 - Lingual edema
Stage 4 - Laryngeal edema

13. 2.RHABDOMYOLYSIS:
 Symptoms are back pain,limb
pain,generalised myalgias
 Acute muscle necrosis is the cause for
tenderness and local edema of muscles

14.  The initial sign of rhabdomyolysis is the
appearance of cola-colored urine
 There is dissolution of striated muscle fibres, with
leakage of muscle Enzymes,myoglobin,
potassium,calcium and other intracellular
constituents.
 CK levels are the most sensitive indicators of
myocyte injury.

15. 3.RENAL FAILURE:
 It testifies to the severity of intoxication.
 The causes are
Toxic injury
Myoglobinuria
Hemoglobinuria
Hypovolemia
Propylene glycol is also a nephrotoxic

16. 4.MYOCARDITIS:
It is due to rhabdomyolysis of myocardium
It is reported in 15% of cases with mortality
rate of 29%.
Ventricular arrythmias,sudden cardiac death
5.Neurological:convulsions

17. Cause of death:
Respiratory obstuction
Renal failure
Arrythmias
ARDS

18.  Treatment is aimed at rapid identification of
potentially life-threatening complications and
prevention of renal failure
 GASTRIC LAVAGE: is useful if the
patient presents within 1 hour of ingestion but
contraindicated if airway protective reflex is lost.
 Airway protection is the most important
consideration with laryngeaal edema…it should
be ensured with timely endotracheal intubation
or tracheostomy.

19.  Steroids – hydrocortisone 200mg stat f/b
100mg every 6th hourly.
If not responded to hydrocortisone ,
methyl prednisolone 125mg iv infusion given
6th hourly

20.  In the event of life threatening reaction
involving urticaria with angioedema or
laryngeal edema Epinephrine may be neded
to stabilise the patient

21.  Aggressive fluid resuscitation
with isotonic fluids to restore the renal
perfusion and increase renal flow is necessary
to prevent AKI

22.  Dialysis support may be life saving when
oliguria develops.
 Myocarditis requires continous cardiac
monitoring in order to timely intervene life-
threatening arrythmias and sudden cardiac
death.

23.  Alkaline diuresis- using isotonic
saline,sodium bicarbonate and diuretics
 Sodabicarb 20meq 8th hourly

24.  In conclusion,hair dye poisoning is a life-
threatening emergency which requires
emergency resuscitation and aggressive
management of anaphylaxis
 Preventing renal failure is a very important
goal,since its occurrence is associated with
high mortality and increase in ICU stay
 The time of development of renal failure is
uncertain and hence all patients should be
monitored in hospital for renal failure
complications…