Household Poisoning References
                    ==============================

Okuonghae HO; Ighogboja IS; Lawson JO; Nwana EJ 
Diethylene glycol poisoning in Nigerian children [see comments] 
Ann Trop Paediatr, 12: 3, 1992, 235-8 
Between June and September 1990, 47 children died at Jos University
Teaching Hospital, Nigeria from ingestion of paracetamol syrup
adulterated with diethylene glycol. Most of the children presented
with anuria, fever, vomiting, diarrhoea and convulsions. Signs on
admission were tachycardia, acidotic breathing, pallor, oedema and
hepatomegaly. Laboratory findings included hyperkalaemia, acidosis,
elevated creatinine level and hypoglycaemia. Management consisted of
correction of dehydration and acidosis plus administration of
antibiotics when indicated. None of the children had dialysis. All
died within 2 weeks of admission. Proper government supervision of
pharmaceutical companies and their agencies is urgently needed in
order to prevent any future occurrence of such tragic deaths. 

Hanif M; Mobarak MR; Ronan A; Rahman D; Donovan JJ Jr; Bennish ML
Fatal renal failure caused by diethylene glycol in paracetamol elixir:
the Bangladesh epidemic [see comments] BMJ, 311: 6997, 1995 Jul 8,
88-91 
OBJECTIVE--To determine the cause of a large increase in the number of
children with unexplained renal failure. DESIGN--Case-control study.
SETTING--Children's hospital in Dhaka, Bangladesh. SUBJECTS--Cases
were all 339 children with initially unexplained renal failure;
controls were 90 children with cause of renal failure identified; all
were admitted to hospital during 35 months after January 1990. MAIN
OUTCOME MEASURES--Differences between the case and control patients in
clinical and histological features and outcome; toxicological
examination of 69 bottles of paracetamol from patients and pharmacies.
RESULTS--Compared with children with an identified cause for their
renal failure, children with initially unexplained renal failure were
significantly (P < 0.05) more likely to have hepatomegaly (58% v 33%),
oedema (37% v 20%), and hypertension (58% v 23%); to have a higher
serum creatinine concentration (mean 519 mumol/l v 347 mumol/l) and
lower serum bicarbonate concentration (10.1 mmol/l v 12.4 mmol/l); to
have been given a drug for fever (91% v 31%); to have ingested a brand
of paracetamol shown to contain diethylene glycol (20% v 0%); and to
have died in hospital (70% v 33%). Diethylene glycol was identified in
19 bottles of paracetamol, from 7 of 28 brands tested. In the 12
months after a government ban on the sale of paracetamol elixir, new
cases of renal failure decreased by 54%, and cases of unexplained
renal failure decreased by 84%. CONCLUSION--Paracetamol elixirs with
diethylene glycol as a diluent were responsible for a large outbreak
of fatal renal failure in Bangladesh. 

Drut R; Quijano G; Jones MC; Scanferla P 
[Pathologic findings in diethylene glycol poisoning] 
Medicina (B Aires), 54: 1, 1994, 1-5 

We are reporting the necropsy findings of 7 patients poisoned with
diethylene glycol-contaminated propolis (a rubbery substance produced
by bees from vegetal resins). Besides the well-known features of
hydropic necrosis of centrolobular areas in the liver and renal
tubules we found acute pancreatitis with diffuse enzymatic fat
necrosis which in two of the cases was considered the secondary cause
of death, and acute demyelinating lesions in the central and
peripheral nervous system. Six out of the 7 cases showed glomerular
PAS-positive arteriolar hyalinosis at the vascular pole, in two of
them widely disseminated. Differing from the findings reported in
ethylene glycol poisoning we could not find calcium oxalate crystals
in any of the cases. The pancreatic, central and peripheral nervous
system lesions as well as the glomerular arteriolar hyalinosis have
not been previously described in the literature in relation with
diethylene glycol poisoning. 


Hébert JL; Auzépy P; Durand A 
[Acute human and experimental poisoning with diethylene glycol] 
Sem Hop, 59: 5, 1983 Feb 3, 344-9 

Although acute poisoning with ethylene glycol (EG) used in antifreeze
mixtures is well known in man, only a few reports have described acute
intoxication with diethylene glycol (DEG) and only one has mentioned
oxaluria. Furthermore, there is no experimental evidence that DEG is
metabolized into oxalate. The ability of ethanol infusions to prevent
hepatic oxidation of DEG has not been proved. Moreover, failure of
this treatment has been reported by some authors. In order to resolve
such questions, Wistar male adult rats possessing a hepatic alcohol
deshydrogenase were given a single oral dose of 15 ml/kg-1 DEG. Rats
were either untreated or treated with hydration alone or associated
with bicarbonate or ethanol. Urinary output, urinary oxalate
excretion, acid-base balance in peripheral blood and renal histology
were studied. Acute poisoning induced metabolic acidosis, polyuria,
hyperoxaluria with renal tubular necrosis and a 66% mortality. Massive
hydration improved acidosis and prognosis, but mortality and renal
lesions were avoided only when bicarbonate or ethanol were added. Only
ethanol significantly decreased oxaluria. In acute DEG poisoning, both
the mechanism and the treatment appear to be the same as in acute EG
intoxication. 

Bowie MD; McKenzie D 
Diethylene glycol poisoning in children. 
S Afr Med J, 46: 27, 1972 Jul 1, 931-4 

Auzépy P; Taktak H; Toubas PL; Deparis M 
[Acute ethylene glycol and diethylene glycol poisoning in adults. 2
cases with recovery] Sem Hop, 49: 19, 1973 Apr 20, 1371-4 

Cantarell MC; Fort J; Camps J; Sans M; Piera L 
Acute intoxication due to topical application of diethylene glycol
[letter] Ann Intern Med, 106: 3, 1987 Mar, 478-9 

van der Linden-Cremers PM; Sangster B 
[Medical sequelae of the contamination of wine with diethylene glycol
(letter)] Ned Tijdschr Geneeskd, 129: 39, 1985 Sep 28, 1890-1 

van Leusen R; Uges DR 
A patient with acute tubular necrosis as a consequence of drinking
diethylene glycol-treated wine] Ned Tijdschr Geneeskd, 131: 18, 1987
May 2, 768-71