title: 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.affiliation: Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. ros2akuse@yahoo.co.uk
authors.forename: Rosamund Modupe
authors.initials: RM
authors.lastname: Akuse
authors.forename: Felicia Uchezuba
authors.initials: FU
authors.lastname: Eke
authors.forename: Adebowale Dele
authors.initials: AD
authors.lastname: Ademola
authors.forename: Iretiola Bamikeolu
authors.initials: IB
authors.lastname: Fajolu
authors.forename: Henry Olusegun
authors.initials: HO
authors.lastname: Gbelee
authors.forename: Ugochi
authors.initials: U
authors.lastname: Ihejiahi
authors.forename: Mairo Adamu
authors.initials: MA
authors.lastname: Bugaje
authors.forename: Ifoema Comfort
authors.initials: IC
authors.lastname: Anochie
authors.forename: Adanze Onyenonachi
authors.initials: AO
authors.lastname: Asinobi
authors.forename: Henrietta Uchenna
authors.initials: HU
authors.lastname: Okafor
authors.forename: Solomon Ibiyemi
authors.initials: SI
authors.lastname: Adeleke
authors.forename: Lamidi Isah
authors.initials: LI
authors.lastname: Audu
authors.forename: Adekunle
authors.initials: A
authors.lastname: Otuneye
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Disu
authors.forename: Hafsat
authors.initials: H
authors.lastname: Idris
authors.forename: Henry
authors.initials: H
authors.lastname: Aikhonbare
authors.forename: Alhassan
authors.initials: A
authors.lastname: Yakubu
authors.forename: William
authors.initials: W
authors.lastname: Ogala
authors.forename: Olufemi
authors.initials: O
authors.lastname: Ogunrinde
authors.forename: Robinson
authors.initials: R
authors.lastname: Wammanda
authors.forename: Adeola
authors.initials: A
authors.lastname: Orogade
authors.forename: Jane
authors.initials: J
authors.lastname: Anyiam
authors.forename: Edwin
authors.initials: E
authors.lastname: Eseigbe
authors.forename: Lawal
authors.initials: L
authors.lastname: Umar
authors.forename: Hafsat
authors.initials: H
authors.lastname: Musa
authors.forename: Richard
authors.initials: R
authors.lastname: Onalo
authors.forename: Boma
authors.initials: B
authors.lastname: West
authors.forename: Nsirimobu
authors.initials: N
authors.lastname: Paul
authors.forename: Folusho
authors.initials: F
authors.lastname: Lesi
authors.forename: Taiwo
authors.initials: T
authors.lastname: Ladapo
authors.forename: Ojombo
authors.initials: O
authors.lastname: Boyede
authors.forename: Rahmon
authors.initials: R
authors.lastname: Okeowo
authors.forename: Akeem
authors.initials: A
authors.lastname: Mustapha
authors.forename: Ibironke
authors.initials: I
authors.lastname: Akinola
authors.forename: Oma
authors.initials: O
authors.lastname: Chima-Oduko
authors.forename: Olugbenga
authors.initials: O
authors.lastname: Awobusuyi
mesh_terms: D000138:Acidosis / Q000139:chemically induced / Q000175:diagnosis; D000700:Analgesics / Q000737:chemistry / Q000627:therapeutic use; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries / Q000191:economics*; D004338:Drug Combinations; D004340:Drug Contamination; D005026:Ethylene Glycols / Q000032:analysis / Q000506:poisoning*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D007677:Kidney Function Tests / Q000191:economics*; D008297:Male; D008487:Medical History Taking; D009102:Multiple Organ Failure / Q000139:chemically induced / Q000175:diagnosis; D009549:Nigeria / Q000453:epidemiology; D011041:Poisoning / Q000175:diagnosis / Q000191:economics / Q000209:etiology; D011237:Predictive Value of Tests; D011379:Prognosis; D006435:Renal Dialysis / Q000191:economics; D051437:Renal Insufficiency / Q000139:chemically induced / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014078:Tooth Eruption / Q000187:drug effects
chemical_list: D000700:Analgesics; D004338:Drug Combinations; D005026:Ethylene Glycols; C013484:diethylene glycol