Academic journal article Bulletin of the World Health Organization

Diethylene Glycol Poisoning in Gurgaon, India, 1998

Academic journal article Bulletin of the World Health Organization

Diethylene Glycol Poisoning in Gurgaon, India, 1998

Article excerpt

Voir page 94 le resume en francais. En la pagina 95 figura un resumen en espanol.

Introduction

The Federal Food, Drug and Cosmetic Act was passed by the United States Congress in 1938 in reaction to a public health accident that occurred in 1937 when 105 people died from diethylene glycol poisoning. Diethylene glycol, a highly toxic organic solvent that causes acute renal failure and death when ingested, was used as a diluent in sulfanilamide, the first sulfa antimicrobial drug (1, 2). The legislation, which was the first to require that new drugs be tested for toxicity before being put on the market, protected the American public against a recurrence of the tragedy. However, despite the existence of similar, appropriate legislation in India, 14 patients died in Bombay (now Mumbai) in 1986 when they were given glycerine contaminated with diethylene glycol (3). We report a second episode of poisoning occurring in 1998 in India as a result of children ingesting diethylene glycol; at least 33 children are known to have died.

Background

Kalawati Saran Children's Hospital is a tertiary level paediatric hospital in Delhi. About 150 cases of acute renal failure were seen in the hospital over the last five years. Paediatricians were able to determine the etiology in most of the cases, but were unable to do so for a large number of children who were admitted from April 1998. Most of these children died. All of these children became ill initially with an acute febrile illness with or without mild respiratory or gastrointestinal symptoms (such as diarrhoea or vomiting, or both). All of the children had been treated by private medical practitioners (qualified as well as unqualified) and had some unknown medicines administered, orally or as injections. After a few days of private treatment, the patients developed severe oliguria or anuria that necessitated admission to the children's hospital. On 5 May 1998 the hospital informed the National Institute of Communicable Diseases about these cases. This triggered an epidemiological investigation to discover the cause. The results are presented in this report.

Materials and methods

The Director of Health Services and the Municipal Health Officer of Delhi were informed about the large number of children with unexplained acute renal failure who had been admitted to the Kalawati Saran Children's Hospital. They were asked to determine whether other hospitals in Delhi had seen similar cases. They found that similar cases had been seen by two other hospitals on or after 19 April 1998: two cases had been admitted to Safdarjang Hospital and 9 to the All India Institute of Medical Sciences. For this investigation, a case was defined as a patient admitted to hospital in April 1998 or later and diagnosed as having unexplained acute renal failure. The 9 cases admitted to the All India Institute have been excluded from this report for administrative reasons. Nevertheless, the excluded cases had epidemiological and clinical characteristics similar to those of the cases admitted to the other two hospitals.

The hospital records of all patients who met the definition of a case were examined to determine the patient's age, sex, place of residence, date of onset of illness, signs and symptoms, results of laboratory investigations, and treatment received before and after hospitalization. Parents of many of the children and the doctors who had treated them were also interviewed. It became apparent that most of the children who had had unexplained acute renal failure came either from the Gurgaon district or had gone there for treatment of acute febrile illness or diarrhoea.

Health officials in the Gurgaon district were contacted to find out whether similar cases had been admitted to the district hospital or to private hospitals in the district. Data were also collected on cases of pyrexia of unknown origin and diarrhoea that had been treated at the district hospital during 1997 and 1998. …

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