Clinical Features and Investigation of Hair Dye Poisoning

In this article, we will discuss the Clinical Features and Investigation of Hair Dye Poisoning. So, let’s get started.

Clinical Features

The poisoning is mainly ingestional for suicidal intent. Symptoms appear within few hours. The main symptoms include angioedema of face, neck, larynx leading to acute breathing problem. There is chocolate brown colored urine. There is a toxic effect of PPD. This is followed by bone pain and tender muscles due to rhabdomyolysis and acute renal failure which may set in due to hypovolemia and intravascular hemolysis or by direct nephrotoxicity of PPD and may even lead to death. Other effects of PPD are liver failure, altered sensorium, convulsions, GI symptoms etc.

The other component resorcinol is corrosive, produces methaemoglobinemia and renal toxicity. The sodium EDTA can produce hypocalcemia and tetany.


Investigation include complete hemogram, blood urea, serum creatinine, electrolytes (Na+, K+, Mg++), CPK, ECG and blood methaemoglobin and myoglobinuria for rhabdomyolysis. LFTs must be done.


Preoperative Respiratory Assessment

In this article, we will discuss the Preoperative Respiratory Assessment. So, let’s get started.

Respiratory Assessment

The followings should be assessed in detail:

  • Chest deformities: Kyphosis, kyphoscoliosis, pes excavatum and pectus carinatum
  • Breathing pattern: Normal rate of respiration 12-16 breaths/min. Inspiration:expiration- 1:2
  • Abnormal breathing patterns: Pursed lip breathing, apnea, hypoapnea, Cheynesokes respiration, ataxic breathing, apneuistic breathing
  • Chest movements: Symmetry of chest movements, depth of respiration, accessory muscle involvement
  • Chest expansion: It can be assessed both by observation and palpation
  • Dyspnea/breathlessness: It is known as increased work of breathing and can be assessed using “The New York Heart Association Scale of Dyspnea”

I- No symptoms with ordinary activities/No breathlessness with exertion

II- Symptoms with ordinary exercise

III- Symptoms with mild exertion

IV- Symptoms at rest

  • Orthopnea: Breathlessness while lying flat.

Clinical Features of Corrosive Acid Poisoning

In this article, we will discuss the Clinical Features of Corrosive Acid Poisoning. So, let’s get started.

Clinical Features

The clinical manifestations depend on the concentration and quantity of acid consumed. The symptoms and signs given below:

A. Ingestional Poisoning

1. Mouth and Oropharynx


  • Pain in mouth, throat and drooling of saliva
  • Difficulty in speech (hoarseness or dysphonia) due to edema of glottis
  • Choking and stridor
  • Constant cough, dyspnea


  • Skin and oropharyngeal burns, ulcers, edema, necrosis, discoloration of mouth
  • Deep mucosal burns may produce anesthesia
  • Drooling of saliva over lips produce charring of skin over angles of mouth, chin and chest
  • In severe cases, the tongue is shapeless, a pulpy mass
  • Teeth may become chalky white and loose shine in severe poisoning (corrosion of teeth)

2. Esophagus


  • Painful swallowing, retrosternal pain, neck pain/tenderness
  • Haematemesis (vomiting with altered blood and mucus)


  • Esophageal burns and ulcers. The mucosa is red and swollen

3. Stomach


  • Epigastric pain, burning and tenderness
  • Vomiting. It is strongly acidic, will cause effervescence on coming in contact with earth and will stain clothes


  • Gastric burns

4. Respiratory tract (due to aspiration)


  • Cough and dyspnea
  • Hoarseness and dysphonia
  • Labored breathing


  • Tracheitis and pneumonia
  • Pleural effusion may develop

Inhalation poisoning (inhalation of gases i.e. chlorine, fluorine, bromine, iodine, etc)


  • Upper respiratory obstruction, cough, dyspnea


  • Non-cardiogenic pulmonary edema (rales, crackles)

Commonly used Benzodiazepines

In this article, we will discuss the Commonly used Benzodiazepines. So, let’s get started.



  • Chlordiazepoxide
  • Clonazepam
  • Diazepam
  • Flurazepam
  • Nitrazepam
  • Prazepam
  • Quazepam


  • Alprazolam
  • Lorazepam
  • Oxazepam

Ultra-short acting

  • Estazolam
  • Midazolam
  • Temazepam
  • Triazolam

Definition of March Fracture

March Fracture

In this article, we will discuss the Definition of March Fracture. So, let’s get started.

It is defined as the fracture of distal 1/3rd of one of the metatarsals (commonly occurring in the second and third metatarsal) as a result of recurrent stress injury. It is more common in soldiers, hikers and individuals who perform long standing work. Symptoms include sharp pain in the foot as soon as the individual takes off his/her shoes and there is associated local edema on the dorsal aspect of the affected foot. March fracture is one of the common cause of foot pain, especially after sudden increase in activities.

Treatment includes reduction/restriction of movements for 6-12 weeks. Wooden-soled shoes or cast as supportive orthosis and conservative pain management (rest, pain killers, hot/cold compression packs).

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