At least three cough syrups tested in the aftermath of the deaths of children in Madhya Pradesh were found to have higher than permissible limits of diethylene glycol (DEG) — a contaminant that is toxic for humans and can lead to acute kidney injury and failure. Testing by state drug regulators revealed that the Gujarat-based Rednex Pharmaceutical’s Respifresh contained 1.3% DEG. The maximum permissible limit of this contaminant in pharmaceuticals is 0.1%. The Relife syrup, manufactured by another Gujarat-based company Shape Pharma, was found to contain 0.6% DEG. And, as earlier reported, the Tamil Nadu-based Sresan pharma’s Coldrif syrup was found to contain a very high 48.6% DEG. What are symptoms of DEG poisoning? At least 14 children died with kidney failure in Madhya Pradesh after consuming the contaminated syrups, with another nine still undergoing treatment. DEG can lead to symptoms such as abdominal pain, vomiting, diarrhoea, inability to pass urine, headache and an altered mental state. More importantly, it can lead to acute kidney injury that may be fatal in children. How is the compound used? The compound enters syrups through a permitted solvent called polyethylene glycol. This compound also has industrial uses as an antifreeze, heat transfer fluid, and emulsifier among others. Hence, there are two different grades of this raw material available — an industrial grade that may contain higher levels of DEG and a pharmaceutical grade where the contaminant level has to be strictly below the permissible limits. Why regulation needs to be uniform An alert was raised by the World Health Organisation (WHO) in 2022 after reports of 70 children dying in The Gambia and another 18 dying in Uzbekistan after consuming syrups manufactured by a Haryana-based and an Uttar Pradesh-based company. This prompted the government to mandate a testing of all batches of syrups meant for export at Central or State drug testing laboratories. One of the experts quoted later, said: “Why should only the syrup meant for export be tested? Why is the regulation different for our own people?” At least 17 children had died in Jammu and Kashmir’s Ramnagar in 2020 after consuming a cough syrup manufactured by a Himachal Pradesh based company. The syrup was later found to contain 34.97% DEG. Another 33 children had died in Gurugram in 1998 after consuming a syrup manufactured by a company based in the same district. The syrup was later found to contain 17.5% DEG. Around 150 children were brought with acute kidney failure to Delhi’s Kalawati Saran Children’s Hospital, which rang the alarm bells.
