Diethylene glycol poisoning in Gurgaon, India, 1998

Objective To discover the cause of acute renal failure in 36 children aged 2 months to 6 years who were admitted to two hospitals in Delhi between 1 A pril and 9 lune 1998. Methods Data were collected from hospital records, parents and doctors of the patients, and district health officials. Further information was obtained from house visits and community surveys; blood an d stool samples were collected from other ill children, healthy family memb ers and community contacts. Samples of drinking-water and water from a tube -well were tested for coliform organisms. Findings Most of the children (26/36) were from the Gurgaon district in Har yana or had visited Gurgaon town for treatment of a minor illness. Acute re nal failure developed after an episode of acute febrile illness with or wit hout watery diarrhoea or mild respiratory symptoms for which the children h ad been treated with unknown medicines by private medical practitioners. On admission to hospital the children were not dehydrated. Median blood urea concentration was 150 mg/dl (range 79-311 mg/dl) and median serum creatinin e concentration was 5.6 mg/dl (range 2.6-10.8 mg/dl). Kidney biopsy showed acute tubular necrosis. Thirty-three children were known to have died despi te being treated with peritoneal dialysis and supportive therapy. Conclusion Cough expectorant manufactured by a company in Gurgaon was found to be contaminated with diethylene glycol (17.5% v/v), but a sample of ace taminophen manufactured by the same company tested negative for contaminati on when gas-liquid chromatography was used. Thus, poisoning with diethylene glycol seems to be the cause of acute renal failure in these children.