Understanding the Contaminated Cough Syrup Crisis
Cough syrups are among the most widely used medicines for relief from cold, cough, and respiratory irritation, especially in children. But not all syrups are created safely. In several tragic cases investigated by the WHO and national health authorities, certain locally manufactured cough syrups were found to contain diethylene glycol and ethylene glycol — cheap industrial solvents used as antifreeze and brake fluids.
These substances are highly toxic to humans. Even small amounts can lead to severe metabolic acidosis, kidney failure, neurological complications, and death — particularly in children whose smaller bodies cannot process toxins efficiently. Unlike pharmaceutical-grade glycerin or propylene glycol (which are safe solvents used in medicines), DEG is a dangerous contaminant that should never be present in cough syrups.
The problem often arises from poor quality control during manufacturing, where contaminated raw materials are used or proper testing is skipped. This highlights a deeper issue: inadequate pharmaceutical regulation and weak enforcement standards, particularly in some low- and middle-income countries.
Real Incidents That Raised the Alarm
The WHO has documented several serious cases in recent years:
1.The Gambia (2022): Over 70 children died after consuming cough syrups linked to an Indian manufacturer. Laboratory tests revealed the presence of diethylene glycol and ethylene glycol far beyond safe limits.
2.Uzbekistan (2022): At least 20 children died from acute kidney injury after taking contaminated cough syrup. Investigations confirmed the presence of toxic glycols.3.India (2023-2024): WHO flagged multiple batches of unsafe cold medicines exported from India. Several countries issued recalls, and India strengthened its drug safety monitoring in response.
These incidents are not isolated. They expose a systemic risk in the global supply chain of medicines and highlight the urgent need for stricter quality control, traceability, and testing protocols.
✦ Major Health Risks of Toxic Cough Syrups
1. Acute Kidney Failure:
Diethylene glycol is metabolized into toxic byproducts that damage kidney tubules, leading to acute renal failure. Children often present with reduced urine output, vomiting, lethargy, and seizures — symptoms that can progress rapidly without treatment.
2. Neurological Damage:
Toxic metabolites affect the central nervous system, causing confusion, seizures, or coma. Survivors may suffer from permanent neurological deficits if treatment is delayed.
3. Metabolic Acidosis:
DEG poisoning disrupts the body’s acid-base balance, leading to life-threatening metabolic acidosis. Rapid medical intervention, often with fomepizole or dialysis, may be necessary.
4. Multi-Organ Failure:
In severe cases, DEG poisoning affects not just kidneys but also the liver, pancreas, and heart, resulting in multi-organ dysfunction and death if not promptly managed.
✦ Recognizing Toxic Cough Syrup Symptoms Early
Parents and caregivers must stay alert to possible signs of poisoning, especially in children who have recently taken cough syrup. Symptoms may include:
1.Persistent vomiting or abdominal pain2.Sudden drowsiness, confusion, or seizures
3.Little or no urine output
4.Rapid breathing or deep sighing (a sign of acidosis)
Any of these symptoms require immediate emergency care. Do not attempt home remedies or delay medical attention.
Safe Usage and Prevention: Doctor’s Practical Tips
*Check WHO and National Alerts: Before buying or using a cough syrup, verify if the product or manufacturer is listed in any WHO Medical Product Alert or national drug safety bulletin.
*Buy Only from Reputable Pharmacies: Avoid unverified online sources or unlabelled local products. Always look for a proper batch number, expiry date, and manufacturer details.*Consult Your Doctor for Children: Never self-medicate young children with OTC syrups. Pediatric doses and safety profiles differ significantly from adults.
*Store Medicines Safely: Keep syrups away from heat and sunlight, and avoid using expired or improperly stored products.
*Prefer Safer Alternatives: Evidence shows that saline nasal drops, honey (for children over 1 year), steam inhalation, and proper hydration can often relieve mild cough and cold without the risks associated with contaminated syrups.
*Report Adverse Events: If you suspect a reaction to any medicine, report it to your country’s pharmacovigilance program. This helps authorities track unsafe products quickly.
This Article Is Reviewed and Written by Dr.Mashir Mughal
Studies have consistently confirmed the dangers of DEG contamination. A 2023 review in the Journal of Clinical Toxicology documented over 500 deaths worldwide since the 1930s linked to DEG-contaminated syrups. Another analysis in the Lancet Global Health (2024) emphasized that weak regulatory oversight and untested raw materials remain major contributors to recurring incidents. The WHO has since strengthened its Global Surveillance and Monitoring System for Substandard and Falsified Medical Products, urging all countries to implement stricter screening.
These findings underscore the need for robust manufacturing standards, transparent supply chains, and routine toxicology testing — essential steps to prevent future tragedies.
This Article Is Reviewed and Written by Dr.Mashir Mughal.
As a physician, I want families to understand that not all medicines are automatically safe — even those sold over the counter. The tragic deaths linked to contaminated cough syrups are preventable if we remain vigilant, informed, and proactive. Always consult your doctor before giving any medicine to a child, and stay updated with WHO safety alerts. Remember: prevention is far more powerful than treatment when it comes to toxic exposures.
FAQs ❓
1. What is diethylene glycol and why is it dangerous?
Diethylene glycol is a toxic industrial chemical used in antifreeze. Ingesting even small amounts can cause kidney failure, neurological damage, and death.
2. How can I know if a cough syrup is contaminated?
Check WHO alerts, national drug safety bulletins, and always verify the manufacturer and batch details. Avoid unlabelled or suspiciously cheap syrups.
3. Are children more vulnerable to DEG poisoning?
Yes, children’s kidneys and metabolic systems are more sensitive, making them particularly vulnerable to small doses of toxins.
4. What should I do if my child shows poisoning symptoms?
Seek emergency medical care immediately. Early intervention, including supportive care and antidotes, can save lives.
5. Are natural remedies safe alternatives to cough syrups?
Mild coughs often improve with saline drops, honey (above 1 year), and steam inhalation. However, consult your doctor before trying any remedy.
Disclaimer: This article is for general educational purposes only and does not replace professional medical consultation. Always seek guidance from a qualified healthcare provider.
