Bad science or medical practices: Who’s really responsible for the Gambia cough syrup deaths?

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Editor's note: Around 70 children have died in the Gambia after consuming cough syrup tainted with diethylene glycol, or DEG. The four implicated products—Promethazine oral solution, Kofexmalin and Makoff baby cough syrups, and Magrip N cold syrup—were manufactured in India by Maiden Pharmaceuticals, which failed to provide safety guarantees for the medicines. DEG is particularly lethal to human beings. An estimated 1-1.63 gm per kg of body mass can be fatal—i.e., as little as one-thousandth of your weight. DEG poisoning typically occurs in three phases. In the first phase, which begins immediately after ingestion, the patient experiences gastrointestinal symptoms such as vomiting and diarrhoea. In the second, which begins within 72 hours, kidney failure sets in, leading to increased levels of acid in the blood (metabolic acidosis), which results in high potassium levels, heart rhythm abnormalities and high blood pressure. In the final stage, which occurs within 10 days, brain complications take over, leading to paralysis, altered mental status and coma, resulting in death. Treatment in the early stage includes the use of fomepizole, which competes with the DEG and prevents toxic …