Diagnosing renal failure due to diethylene glycol in children in a resource-constrained setting.

Abstract

BACKGROUND:

In 2008, several Nigerian children developed acute kidney injury (AKI) after ingesting teething syrup contaminated with diethylene glycol (DEG). Because there are limited diagnostic facilities in resource-constrained countries, this study investigated whether AKI associated with DEG could be identified by other means.

METHODS:

This was a multicenter study. Information was obtained from hospital records. Clinicopathological features of all children with AKI over a 6-month period were reviewed.

RESULTS:

Sixty (50.4%) of 119 children ingested "My pikin" teething syrup. Compared to children who had not ingested it, they were significantly (p < 0.05) younger (11.95 vs. 31 months), more were anuric (98.3 vs. 74.6%), hypertensive (84 vs. 52%), had severe metabolic acidosis (46.7 vs. 20.5%), and died (96.6 vs. 71.2%). They developed increasing metabolic acidosis and multiorgan dysfunction despite peritoneal dialysis. Late presentation, financial difficulties, inadequate facilities for toxicology, and hemodialysis complicated management.

CONCLUSIONS:

Identifying AKI associated with DEG is difficult. Detailed drug history, increasing metabolic acidosis, and multiorgan deterioration despite peritoneal dialysis should arouse suspicion. Simple diagnostic tests need to be developed and facilities for hemodialysis of infants and financial support provided. Recurrences can be prevented by creating awareness, improving manufacturing practices, field-testing of drugs, and international monitoring of pharmaceuticals imported for manufacture.

• Authors: Rosamund Modupe Akuse, Felicia Uchezuba Eke, Adebowale Dele Ademola, Iretiola Bamikeolu Fajolu, Henry Olusegun Gbelee, Ugochi Ihejiahi, Mairo Adamu Bugaje, Ifoema Comfort Anochie, Adanze Onyenonachi Asinobi, Henrietta Uchenna Okafor, Solomon Ibiyemi Adeleke, Lamidi Isah Audu, Adekunle Otuneye, Elizabeth Disu, Hafsat Idris, Henry Aikhonbare, Alhassan Yakubu, William Ogala, Olufemi Ogunrinde, Robinson Wammanda, Adeola Orogade, Jane Anyiam, Edwin Eseigbe, Lawal Umar, Hafsat Musa, Richard Onalo, Boma West, Nsirimobu Paul, Folusho Lesi, Taiwo Ladapo, Ojombo Boyede, Rahmon Okeowo, Akeem Mustapha, Ibironke Akinola, Oma Chima-Oduko, Olugbenga Awobusuyi
• Journal: Pediatric nephrology (Berlin, Germany) (Pediatr Nephrol) Vol. 27 Issue 6 Pg. 1021-8 (Jun 2012) ISSN: 1432-198X [Electronic] Germany
• PMID: 22246572 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Analgesics
• Drug Combinations
• Ethylene Glycols
• diethylene glycol

Topics

• Acidosis (chemically induced, diagnosis)
• Analgesics (chemistry, therapeutic use)
• Chi-Square Distribution
• Child
• Child, Preschool
• Developing Countries (economics)
• Drug Combinations
• Drug Contamination
• Ethylene Glycols (analysis, poisoning)
• Female
• Health Care Costs
• Humans
• Infant
• Kidney Function Tests (economics)
• Male
• Medical History Taking
• Multiple Organ Failure (chemically induced, diagnosis)
• Nigeria (epidemiology)
• Poisoning (diagnosis, economics, etiology)
• Predictive Value of Tests
• Prognosis
• Renal Dialysis (economics)
• Renal Insufficiency (chemically induced, diagnosis, economics, epidemiology, therapy)
• Risk Assessment
• Risk Factors
• Time Factors
• Tooth Eruption (drug effects)