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

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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.

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Author information

Authors and Affiliations

  1. Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

    Rosamund Modupe Akuse, Mairo Adamu Bugaje, Hafsat Idris, Henry Aikhonbare, Alhassan Yakubu, William Ogala, Olufemi Ogunrinde, Robinson Wammanda, Adeola Orogade, Jane Anyiam, Edwin Eseigbe, Lawal Umar, Hafsat Musa & Richard Onalo

  2. University of Port Harcourt Teaching Hospital, PortHarcourt, Nigeria

    Felicia Uchezuba Eke, Ifoema Comfort Anochie, Boma West & Nsirimobu Paul

  3. University College Hospital, Ibadan, Nigeria

    Adebowale Dele Ademola & Adanze Onyenonachi Asinobi

  4. Lagos University Teaching Hospital, Lagos, Nigeria

    Iretiola Bamikeolu Fajolu, Folusho Lesi, Taiwo Ladapo, Ojombo Boyede & Rahmon Okeowo

  5. Lagos State University Teaching Hospital, Lagos, Nigeria

    Henry Olusegun Gbelee, Elizabeth Disu, Akeem Mustapha, Ibironke Akinola, Oma Chima-Oduko & Olugbenga Awobusuyi

  6. Nigerian Army Reference Hospital Yaba, Lagos, Nigeria

    Ugochi Ihejiahi

  7. University of Nigeria Teaching Hospital, Enugu, Nigeria

    Henrietta Uchenna Okafor

  8. Aminu Kano University Teaching Hospital, Kano, Nigeria

    Solomon Ibiyemi Adeleke

  9. National Hospital, Abuja, Nigeria

    Lamidi Isah Audu & Adekunle Otuneye

Authors
  1. Rosamund Modupe Akuse
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  2. Felicia Uchezuba Eke
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  3. Adebowale Dele Ademola
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  14. Elizabeth Disu
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  27. Boma West
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  34. Ibironke Akinola
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  35. Oma Chima-Oduko
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  36. Olugbenga Awobusuyi
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Corresponding author

Correspondence to Rosamund Modupe Akuse.

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Akuse, R.M., Eke, F.U., Ademola, A.D. et al. Diagnosing renal failure due to diethylene glycol in children in a resource-constrained setting. Pediatr Nephrol 27, 1021–1028 (2012). https://doi.org/10.1007/s00467-011-2082-8

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  • DOI: https://doi.org/10.1007/s00467-011-2082-8

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