Friday, March 29, 2024 | 22:07 WIB

INDONESIA LINKS MEDICINAL SYRUPS TO CHILD DEATHS: Who’s to blame?

READ MORE

The first case of EG/DEG poisoning was diagnosed in 1937 in several states in the US, resulting in the deaths of more than a hundred people, including children. This became known as the “Elixir Sulfanilamide Incident.” Sulfanilamide is a drug commonly used to treat streptococcal (strep) infections, shown to be effective when it is taken in a tablet or powder form. However, in midJune 1937, a salesman for the US pharmaceutical company S.E. Massengill reported a demand for sulfanilamide in liquid form. It was at his request that sulfanilamide was then manufactured in a liquid form. The diluting agent used in its production was none other than DEG. 

The pharmaceutical company’s follow-up experiments to test the concoction for taste, appearance, and scent produced a satisfying result. Thus, a sulfanilamide antibiotic syrup with a sweet raspberry taste was born. It was distributed to 15 states in the US. Some studies in 1937 soon revealed that DEG was toxic and could cause kidney damage or failure. The only problem at the time was that there were no regulations in place to prohibit the sale of untested, dangerous or even toxic drugs. The incident sparked a public outcry and led to the passage of one of the first pieces of legislation determining safe medications for release in North America. 

In 1990, between August and October, there were reports that 25 children undergoing treatment for unrelated illnesses at Dhaka Shishu Hospital, Bangladesh, were also diagnosed with AKI. They had one thing in common: all had taken the paracetamol syrup dispensed by the hospital’s pharmacy, which was later found to contain DEG. The Bangladeshi government thus moved to ban the sale of the paracetamol syrup in December 1992. 

In the 12 months after the ban, the total number of patients with renal failure decreased from 187 to 89 (53 percent) and for unexplained renal failure, in particular, fell precipitously from 162 to 26 (84 percent). In the second half of 1993, only one patient with unexplained renal failure was treated. It was believed that the drug manufacturer had replaced a safe solvent, propylene glycol, with DEG, a much cheaper alternative.

Mass poisoning incidents involving DEG around the world

Medicines contaminated with DEG in a number of countries during the past 20 years have resulted in the deaths of more 300 children. 

In Indonesia, 97.34 percent of EG is used as raw material in the manufacturing of textiles (polyester) and 2.66 percent as an additional raw material in the production of paints, liquid glue, solvents, printing ink, ballpoint ink, foam stabilizers, cosmetics and anti-freeze ingredients. 

DEG and EG are organic solvents with a sweet taste, often misused as a drug solvent to supplant propylene glycol or polyethylene glycol. When it enters the body, this compound is oxidized by enzymes into glycol aldehyde then re-oxidized into glycol oxalic acid, which then becomes oxalic acid – potentially growing kidney stones. If this condition occurs in children, they will suffer gastrointestinal bleeding, seizures and liver and kidney failure, which can further damage the heart and lung, causing sudden unexpected death. 

Almost all the children under five who died from AKI shared a common thread: they had all consumed cough syrups tainted with EG and DEG. 

POPULAR

Latest article

Related Articles

INFRAME

SOCIAL CULTURE