Most people who ingested these contaminated products were children who died from severe kidney failure and respiratory paralysis. Although most mass poisonings with DEG have involved poor countries, it is clear that developed countries are at risk from pharmaceutical counterfeits from countries with poor quality control measures, particularly China.
Why Diethylene Glycol Poisonings Happen
Most cases of diethylene glycol poisoings are believed to have occurred because of pharmaceutical counterfeits involving glycerine (or glycerol), which is widely used in drug formulations and personal care products. DEG and glycerine are both clear, odorless, sweet-tasting liquids, but DEG is much easier and cheaper to manufacture. As a result, DEG poisonings have typically occurred because homicidal greed and poor quality control measures in the formulation and dispensing of medications.
Diethylene Glycol (DEG) Toxicity
Diethylene glycol is chemically related to ethylene glycol, which is commonly used as an antifreeze. Although the exact mechanism of how DEG ingestion leads to kidney failure and death is not known for sure, it is thought to act similar to that of ethylene glycol poisoning.After DEG is ingested, it is likely converted by the liver into toxic compounds that lead to a sudden and total shut down of the kidneys (very little urine output), severe acidity in the blood (metabolic acidosis), inflammation of the liver (hepatitis) and neurological dysfunction including paralysis.
Because most people die before it is realized what is going on, treatment regimens for DEG poisoning have not been definitively studied in humans. However, because of the similarities between it and ethylene glycol poisoning, similar treatment approaches are recommended. This includes hemodialysis (to remove the DEG and toxins), bicarbonate (to treat the low blood acidity), intravenous fluids and diuretics (to support the blood pressure and flush out the kidneys), and drugs to prevent the conversion of DEG to its toxic forms.
History of Mass DEG Poisonings
There has been a number of mass DEG poisonings around the world but the most famous case involved contamination of an antibiotic elixir (sulfanilamide) in the United States in 1937. This led to the deaths of over 100 Americans and ultimately to the creation of the U.S. Food and Drug Administration (FDA). The most recent case occurred in Panama in 2006 and involved cough syrup being made from counterfeit glycerine. This last case was particularly remarkable because the source of the counterfeit glycerin was identified and ultimately traced to China.
Sources:
Bach, Peter. “Acute Renal Failure Associated With Occupational and Environmental Settings.” Acute Renal Failure: A Companion to Brenner and Rector’s The Kidney. Eds. Molitoris & Finn. Philadelphia: W.B. Saunders Company, 2001. 414-423.
Bogdanich, Walt and Hooker, Jake. "From China to Panama, a Trail of Poisoned Medicine." New York Times, May 6, 2007.