Coldrif cough syrup caused death to many kids. Why?
The Coldrif cough syrup is reported to be manufactured by Sresan Pharma, located in Kanchipuram, Tamil Nadu.
Here’s a summary of what is known so far about the Coldrif cough syrup case, and why it’s believed to have caused deaths in children:
What happened
- Several children in Madhya Pradesh (MP) and Rajasthan, India, died after consuming a cough syrup called Coldrif.
- The deaths were associated with kidney failure (acute kidney injury) and symptoms like vomiting, loss of urine output, etc.
- Because of these reports, authorities in Tamil Nadu banned the sale of Coldrif. The manufacturing plant (in Kancheepuram, Tamil Nadu) was also ordered to freeze its stock and halt production for investigation.
Why it’s believed to be dangerous
- Diethylene glycol (DEG), a toxic industrial chemical, was found in the syrup. Authorities say levels were beyond permissible limits.
- Batch number SR-13 of Coldrif (manufactured in May 2025, expiring April 2027) is one particular lot that has been reported to be “not of standard quality” due to DEG adulteration (48% in one report).
What is diethylene glycol (DEG), and why is it dangerous?
- DEG is a chemical used in industrial applications (like antifreeze, brake fluid). It is not safe for ingestion.
- If ingested, especially by children, it can cause damage to the kidneys, leading to kidney failure. It can also affect multiple organs, possibly being fatal.
Uncertainties / Ongoing investigation
- While lab results have confirmed DEG contamination in at least one batch, full details for all deaths are still under investigation. The exact link for each case (which batch, how much quantity, how soon after dose, etc.) is not fully established in public.
- The government has issued advisories, including cautioning against cough syrups for children under 2 years and recommending close supervision for children under 5.
The chemical formula of diethylene glycol (DEG) is:
C4H10O3
Structure:
- It is composed of two ethylene glycol units connected by an oxygen atom.
- Structural formula:
HO-CH2-CH2-O-CH2-CH2-OH
👉 It is a clear, colorless, odorless, and sweet-tasting liquid — which is why accidental or intentional adulteration in syrups is particularly dangerous, since it can go unnoticed in taste.
Why did they added DEG?
They might not intentionally add diethylene glycol (DEG) as an ingredient — it usually gets into medicines because of contamination or adulteration during the manufacturing process. Here’s why it happens:
1. Cheap substitute for glycerin or propylene glycol
- In syrups, glycerin or propylene glycol are used as solvents (to dissolve the medicine) and as sweet-tasting carriers.
- Some unethical suppliers replace them with diethylene glycol (DEG) because it is much cheaper.
- DEG looks similar, tastes sweet, and mixes well with water, so it can go unnoticed unless properly tested.
2. Poor quality control
- In some cases, DEG contamination happens when glycerin or propylene glycol is not purified properly and contains DEG as an impurity.
- If the pharma company skips rigorous quality testing of raw materials, contaminated batches can reach the final product.
3. Historical pattern
- This is not the first time. Tragic outbreaks due to DEG-contaminated medicines have occurred multiple times:
- 1937, USA (Elixir Sulfanilamide tragedy): Over 100 deaths.
- 1990s, Haiti, Bangladesh, Nigeria, India: Several child deaths from DEG in cough syrups.
- Each time, the root cause was either intentional adulteration for cost-cutting or failure in testing raw materials.
👉 So, in Coldrif’s case, the most likely reasons are:
- Adulteration by raw material suppliers (replacing glycerin/propylene glycol with cheaper DEG), or
- Negligence in testing the ingredients before use by the manufacturer.
In syrups like Coldrif, a solvent is needed to:
- dissolve the active drug,
- make the syrup smooth and sweet,
- keep it stable for long storage.
Normally, safe solvents such as glycerin, propylene glycol, or sorbitol are used.
But in this tragedy, diethylene glycol (DEG) — a toxic industrial solvent — ended up in place of (or mixed with) glycerin/propylene glycol.
So yes, DEG acted as the solvent in the syrup, but since it’s poisonous, it caused kidney failure and deaths in children.
How does Diethylene glycol damage the organ?
Let us break it down step by step — how diethylene glycol (DEG) damages the human body (especially in children):
1. Absorption
- When a child drinks syrup containing DEG, it gets absorbed quickly in the stomach and intestines.
- Because DEG is colorless, odorless, and sweet, the body doesn’t recognize it as harmful at first.
2. Metabolism in the liver
- In the liver, DEG is broken down by enzymes into toxic metabolites, mainly:
- 2-hydroxyethoxyacetic acid (HEAA)
- diglycolic acid (DGA)
- These metabolites are far more dangerous than DEG itself.
3. Kidney damage (Acute Kidney Injury)
- DGA accumulates in the kidneys and destroys kidney tubules.
- The kidneys can’t filter blood properly → leading to acute renal failure.
- Symptoms: less urine (or no urine), swelling, vomiting, abdominal pain.
- In children, kidney failure comes on very fast because their kidneys are smaller and more vulnerable.
4. Nervous system & metabolic effects
- DEG and its metabolites also damage the nervous system and cause metabolic acidosis (blood becomes dangerously acidic).
- This affects breathing, heart rhythm, and brain function.
5. Multi-organ failure
- Without treatment, the cascade goes:
Kidney failure → metabolic acidosis → brain swelling & seizures → heart failure → death.
6. Why children die more quickly
- Children have lower body weight, so the toxic dose is reached with much smaller amounts.
- Their detox systems (liver & kidneys) are less developed.
- Even a few spoonfuls of DEG-contaminated syrup can be lethal.
⚠️ Bottom line: DEG is not just a bad solvent — it is a potent poison that acts like antifreeze inside the body, shutting down kidneys and other vital organs.
How is it treated?
Let’s go step by step on how doctors treat diethylene glycol (DEG) poisoning.
1. Immediate supportive care
- Stop exposure → no more intake of the syrup.
- Stabilize breathing, blood pressure, and hydration.
- Hospitalize immediately (because the damage progresses quickly).
2. Antidotes
Doctors use the same antidotes as for ethylene glycol or methanol poisoning, because DEG follows a similar metabolic pathway.
- Fomepizole (preferred): blocks the enzyme alcohol dehydrogenase so DEG is not converted into toxic acids.
- Ethanol (medical alcohol) (alternative if fomepizole unavailable): it competes with DEG for the same enzyme, slowing down toxic metabolism.
👉 These must be given early (before too much DEG is metabolized).
3. Hemodialysis
- Since DEG and its toxic byproducts circulate in the blood, dialysis is often required.
- It removes DEG, diglycolic acid, and corrects metabolic acidosis.
- Dialysis also helps when kidneys have already started to fail.
4. Correcting acidosis
- IV sodium bicarbonate is given to counteract the severe acidosis (acidic blood).
- This stabilizes heart and brain function.
5. Managing complications
- If seizures occur → anticonvulsants.
- If there’s swelling in the brain → mannitol or other measures to reduce intracranial pressure.
- Intensive monitoring of urine output, electrolytes, and heart rhythm.
6. Prognosis
- If treated very early, some patients can recover.
- If treatment is delayed (especially in children), DEG damage to kidneys and organs is often irreversible, leading to death.
⚠️ That’s why in tragedies like the Coldrif case, once children came to hospital with vomiting, no urine, and seizures — it was often too late.