FROM CHIPS TO CYANOSIS: A CASE REPORT OF BLACK STONE (PARAPHENYLENEDIAMINE) POISONING WITH CRITICAL CARE AND PHYSIOTHERAPY REHABILITATION

Abstract

Background: Black stone poisoning is a serious medical emergency that is common in South Asian countries. It can quickly cause swelling of the face and throat, breathing problems, kidney injury, muscle damage, and failure of multiple organs. There is limited information about the role of physiotherapy in the recovery of these patients.

Case Presentation: A 15-year-old girl was admitted with severe breathing difficulty after her family initially reported that she had choked while eating potato chips. She rapidly developed swelling of the face, tongue, and throat, requiring an emergency tracheostomy. Further investigation confirmed intentional ingestion of black stone . She later developed respiratory failure, rhabdomyolysis, acute kidney injury, and multiorgan dysfunction, requiring mechanical ventilation and intensive care treatment.

Intervention: After her condition became stable, physiotherapy was started in the intensive care unit. Treatment included proper positioning, airway clearance, breathing exercises, passive and active-assisted limb exercises, inspiratory muscle training, early mobilization, muscle strengthening, balance training, walking practice, and activities of daily living. Rehabilitation was progressed according to the patient's condition.

Outcome: The patient showed improvement in breathing, muscle strength, mobility, and overall function. She was successfully weaned from the ventilator, maintained normal oxygen levels on room air, walked with minimal assistance, and was able to perform basic daily activities before discharge. Functional outcome measures also showed significant improvement.

Conclusion: This case shows that early diagnosis, timely airway management, intensive care, and structured physiotherapy rehabilitation are important for the recovery of patients with severe black stone poisoning. Early rehabilitation can improve breathing, reduce muscle weakness, restore mobility, and help patients regain independence. More studies are needed to develop standard physiotherapy guidelines for patients recovering from this poisoning