Fatal renal failure caused by diethylene glycol in paracetamol elixir: the Bangladesh epidemic.
OBJECTIVE--To determine the cause of a large increase in the number of children with unexplained renal failure. DESIGN--Case-control study. SETTING--Children's hospital in Dhaka, Bangladesh. SUBJECTS--Cases were all 339 children with initially unexplained renal failure; controls were 90 children with cause of renal failure identified; all were admitted to hospital during 35 months after January 1990. MAIN OUTCOME MEASURES--Differences between the case and control patients in clinical and histological features and outcome; toxicological examination of 69 bottles of paracetamol from patients and pharmacies. RESULTS--Compared with children with an identified cause for their renal failure, children with initially unexplained renal failure were significantly (P < 0.05) more likely to have hepatomegaly (58% v 33%), oedema (37% v 20%), and hypertension (58% v 23%); to have a higher serum creatinine concentration (mean 519 mumol/l v 347 mumol/l) and lower serum bicarbonate concentration (10.1 mmol/l v 12.4 mmol/l); to have been given a drug for fever (91% v 31%); to have ingested a brand of paracetamol shown to contain diethylene glycol (20% v 0%); and to have died in hospital (70% v 33%). Diethylene glycol was identified in 19 bottles of paracetamol, from 7 of 28 brands tested. In the 12 months after a government ban on the sale of paracetamol elixir, new cases of renal failure decreased by 54%, and cases of unexplained renal failure decreased by 84%. CONCLUSION--Paracetamol elixirs with diethylene glycol as a diluent were responsible for a large outbreak of fatal renal failure in Bangladesh.[1]References
- Fatal renal failure caused by diethylene glycol in paracetamol elixir: the Bangladesh epidemic. Hanif, M., Mobarak, M.R., Ronan, A., Rahman, D., Donovan, J.J., Bennish, M.L. BMJ (1995) [Pubmed]
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