Outside the Pediatric Intensive Care Unit (PICU) of Government Medical College & Hospital, Nagpur, Neelesh Suryavanshi paced anxiously, waiting for some sign of hope. His three-and-a-half -year-old son, Mayank, lay inside, fighting for his life.
The doctors had already told him his son’s condition is critical, and he is now torn between holding on and preparing to let go.
When asked how much of the now-banned Coldrif syrup he had given his child, he looks down, eyes welling up: “Hamara baccha to davayi le bhi nahi raha tha. Jahar ko jabardasti pilaya hai humne.” (Our child wasn’t even taking the medicine. We forcefully made him drink the poison)
Mayank’s father who is a farm labourer has till now spent over Rs 4-5 lakh on his treatment.
He first brought his son to Nagpur on September 25, admitted him to a private hospital and then shifted him to the government hospital.
“Sab idhar udhar se udhar manga, karja liya” (I asked for money from everyone, took a loan).
As many 14 children from Madhya Pradesh’s Chhindwara had died due to suspected renal failure, linked to the consumption of a “toxic” cough syrup.
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An FIR was also lodged against Dr Praveen Soni, a paediatric specialist for allegedly prescribing contaminated cough syrup.
Another heartbroken family waits for their daughter’s body, waiting to take her for post-mortem.
Rajesh Yaduvanshi, father of two-year-old Jayusha, carried her little body wrapped in a dupatta in his arms as he walked away from the PICU ward for post mortem.
Standing beside him, Jayusha’s uncle Yogesh told The Indian Express, “We brought Jayusha to Nagpur on September 25. Before that in Parasia, she was admitted at Dr Soni’s hospital for over three days, she was later discharged.”
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On Tuesday, two children lost their lives linked to consumption the Coldrif cough syrup.
Two-and-a-half-year-old Vedansh Pawar, who had been undergoing treatment at Colors Hospital in Nagpur for over a month, and little Jayusha, both died in Nagpur.
Medical Health Officer of the Nagpur Municipal Corporation Dr Deepak Selokar told The Indian Express that there are 14 deaths from Madhya Pradesh and 6 deaths from Maharashtra, due to Acute Encephalitis Syndrome (AES).
Dr Selokar informed that they are still not linking all the deaths to the Coldrif cough syrup and maintaining it as a suspicion.
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“The common factor in the cases admitted from Madhya Pradesh was the cough syrup. But that has not been identified in the cases from Maharashtra,” he said.
Total 36 cases of AES are now on record, Dr Selokar added.
Dr Manish Tiwari, professor and head of Department of Paediatrics, GMC, Nagpur, told The Indian Express, “It has now been made it compulsory that the post-mortems be performed. We had given the relatives the option, explaining that if they were to get any compensation later, they would need proof that this was a case of poisoning. However, none of them initially agreed. Now, we have made it compulsory.”
He further explained that in case of Jayusha, who died on Tuesday, upon admission, her creatinine was 4.4 and Urea was 62, significantly higher than the normal range which should be below 20. She was referred to GMC from a private hospital.
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Fomepizole, which the doctors are using to treat the affected children showed no improvement in the patient.
“This is because the Diethylene Glycol (DEG) gets stuck on the brain; it doesn’t leave the body through dialysis. It binds to tissue, and once it’s bound, it cannot be removed. The death can therefore be attributed to brain damage. She (Jayusha) was in a deep coma and did not come out of it,” said Dr Ashish Lothe, professor Department of Paediatrics.
“The antidote is Fomepizole, but it is not a sure shot. The toxin levels are so high that there is no proven drug. There is nearly a 100 percent fatality rate,” Dr Ashish Lothe said.
When asked, what do they think about the children admitted currently, Dr Tiwari said, “We are keeping our fingers crossed.”
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“Frankly speaking, the toxic level what they found in this syrup is 48.6 percent. That is nearly 500 to 600 times the toxic level, which is 0.1 percent. The children have received multiple doses, drinking this highly toxic dose for two or three days. Just a single 5 ml dose was enough to be fatal,” Dr Tiwari added.
The search for common link: the cough syrup
“We were initially notified that this was AES. The first two or three patients were presented very late, so they had already developed pure encephalopathy and were not responding. When we received those patients, we also didn’t suspect anything initially. However, the fourth patient who came to us gave a key, atypical history: the baby was not passing urine, was conscious, and then went into encephalopathy,” Dr Tiwari explained.
The normal course in acute encephalitis is that the patient first gets a fever, the brain is affected, and then a kidney injury occurs due to multi-organ failure.
In this case, it was the opposite: kidney injury occurred first, and symptoms of brain involvement developed two or three days later. This was not fitting any known picture, he added.
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“Then, we checked the prescriptions and found that the maximum number of patients had been treated by Dr Soni,” Dr Tiwari said.
At the same time, doctors started searching for these kinds of cases and found them in medical literature, including cases outside India.
There was one study from Oman and another from Gambia. In Gambia last year, 66 children died due to the same issue, the doctors said.
“Coldrif has been in the market for ages. The issue isn’t the ingredient; the solvent is the problem. If the polymerization isn’t done properly, instead of becoming Sorbitol, it becomes Diethylene Glycol,” Dr Tiwari said.
No patient has been cured completely
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“Eventually, there was some confusion regarding AES. Some babies who had an infectious form of AES were discharged and went home, leading people to think, ‘this (DEG poisoning) and that (AES) are the same,’ but they are not DEG cases. No one with DEG poisoning has been cured, yet,” Dr Tiwari added.
Now, GMC has three children being treated for AES.
One, Harsh Yaduvanshi from Parasia is being shifted to AIIMS, Nagpur to continue his treatment on CRRT (Continuous Renal Replacement Therapy) machine.
This is a slow, continuous, 24-hour dialysis process used in the intensive care unit (ICU) for critically ill patients with acute kidney injury (AKI).
Dr Tiwari said that once the machine is attached, the patient cannot be removed from it for 72 hours.
With two more patients in GMC, one has already been shifted to CRRT machine, taken on rent from government for Rs 1.72 lakh, while the GMC prepares to procure another machine for another kid in a day.
