The major use of ethylene glycol and diethylene glycol is as an antifreeze agent in the coolant in for example, automobiles and air-conditioning systems. In the plastic industry, ethylene glycol is an important precursor to polyester fibers and resins.
Upon ingestion, ethylene glycol and diethylene glycol are oxidized into glycolic acid, which is, in turn, oxidized to oxalic acid, which is toxic. It and its toxic byproducts first affect the central nervous system, then the heart, and finally the kidneys. Ingestion of sufficient amounts is fatal if left untreated.
So, why would you ingest this highly toxic fluid? Why would you drink your car's antifreeze? You can ingest it because of criminal neglect.
The were a number of incidents in which glycerine (glycerol), one of the regular ingredients in cough syrup, has been replaced with ethylene glycol and/or diethylene glycol leading to some mass poisonings. Ethylene glycol and diethylene glycol simply are less-expensive alternatives to glycerine for industrial applications, however, both nephrotoxic and can result in Multiple Organ Dysfunction Syndrome (MODS), especially in children.
Toxic effects can include abdominal pain, vomiting, diarrhoea, inability to pass urine, headache, altered mental state, and acute kidney injury which may lead to death.
The latest cases of toxic cough syprup occured in The Gambia and Indonesia. In October 2022, the WHO announced a link between four brands of paediatric cough syrups from one Indian pharmaceutical company and the deaths of (to date) 66 children in The Gambia from kidney failure[1]. The products (Promethazine Oral Solution, Kofexmalin Baby Cough Syrup, Makoff Baby Cough Syrup, and Magrip N Cold Syrup) are believed to be contaminated with diethylene glycol and/or ethylene glycol. The products involved were manufactured by the Indian producer Maiden Pharmaceuticals. The syrups have been imported via Atlantic Pharmaceuticals Company Ltd, an somewhat shady US-based pharmaceutical company.
On October 20, 2022, Indonesia reported at least 99 pediatric deaths as a result of 'syrup medicines' that contained ethylene glycol and diethylene glycol.
On December 28, 2022, Uzbekistan reported the death of 18 children after they consumed India-made syrup that - you guessed it - contained ethylene glycol. According to the Uzbek Health Ministry, the syrups were manufactured by Indian drugmaker Marion Biotech. Again. Indians never learn.
On October 05, 2023, a report was published that syrups, for cough and allergic rhinitis, from two Indian manufacturers have been found to contain higher than permissible levels of contaminants – diethylene glycol and ethylene glycol. Cheating and corruption is endemic in India.
We propose to call this Chronic Kidney Disease of non-Traditional causes (CKDnT): Ethylene Glycol-Induced Chronic Kidney Disease.
[1] WHO: Medical Product Alert N°6/2022: Substandard (contaminated) paediatric medicines: Substandard (contaminated) paediatric medicines identified in WHO region of Africa – 5 October, 2022. See here.
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