Clinical Spectrum of Black Stone Poisoning in Paediatrics; An Experience in a Tertiary Care Hospital

Abstract

Objective: This study was designed to document the clinical presentation, laboratory findings, complications, and outcomes of black stone poisoning in pediatric patients.

Methodology: This retrospective study was conducted on 58 children under 15 years of age, with moderate to severe black stone poisoning, having moderate to severe symptoms, requiring ICU care, and thus admitted in Pediatric Intensive Care Unit of Children’s Hospital Lahore. The study duration was between May 2019 to September 2023. Data included demographics, clinical features, lab results, and treatment strategies.

Results: Among total of 58 children, 38 % were female and 62 % were male, with most frequent age 1 to 5 years. Symptoms appeared within 1 to 2 hours of ingestion, with most patients seeking care within 3 to 6 hours. Common symptoms included facial swelling (100%), neck swelling (96.6%) and difficulty in breathing (79.3%). Complications included angioedema (97%), cola-colored urine (100%), metabolic acidosis (86%), ARDS (5.2%), hepatitis (10.3%), and shock (62.15%). The mortality rate was 7%.

Conclusion: Black stone poisoning in children is severe, requiring supportive care, early airway intervention, and renal replacement therapy. Public education on the dangers of Paraphenylenediamine and improved management strategies are essential.

Keywords: Acute Kidney Injury, Angiodema, Black Stone, Paraphenylenediamine, Pediatric Poisoning, Respiratory Distress