Cough syrup deaths: A simple scientific explanation for concerned readers

Dr. M A Mujeeb | drmujeebwrites.blogspot.com 

Several news outlets reporting the cluster of tragic child deaths after taking cough syrup in the state of Madhya Pradesh, India has alarmed families and health officials. This article explains what happened, why certain syrups can be deadly, how the poisoning works in the body, and what parents and health workers should watch for.

Background

Young children developed ordinary cold symptoms, were given over‑the‑counter cough syrups, and within a day or two their condition worsened rapidly leading to vomiting, reduced urine, extreme lethargy, breathing trouble and, in several cases, death. Investigations are ongoing, and regulators have temporarily pulled suspect products for testing.

Who is most at risk?

• Infants and toddlers (especially under 5 years) because their organs and drug processing systems are immature.
• Children given age‑inappropriate medicines or excessive doses.
• Anyone exposed to contaminated or poorly manufactured medicines.

Possible causes

• Contamination with industrial solvents like diethylene glycol (DEG) or ethylene glycol (EG). These are toxic if accidentally used in place of safe pharmaceutical solvents.
• Toxic or inappropriate excipients (non‑active ingredients) added cheaply.
• Overdose or misuse of active drugs not recommended for young children (for example, certain antitussives or antihistamines).
• Underlying infections or interactions that worsened the child’s condition.

How solvent poisoning harms the body?

1. The child swallows the contaminated syrup.
2. The solvent is absorbed into the bloodstream and transported to the liver.
3. Liver enzymes convert the solvent into acidic chemicals.
4. These acidic products cause,

• Severe metabolic acidosis (blood becomes too acidic), which disrupts heart and brain function.
• Direct damage to kidney cells, leading to acute kidney injury and reduced urine output.
• In the case of EG, formation of oxalate crystals can block kidney tubules and worsen kidney failure.

5. If untreated, the combination of acidosis, kidney failure, electrolyte imbalance and reduced breathing leads to multi‑organ collapse.
   

Fig. Pathway leading to death due to DEG contamination

Signs to watch for after a child takes medicine

• Persistent vomiting, decreased urine, confusion or extreme sleepiness.
• Rapid or difficult breathing, seizures, or pale/cold skin.
• These are emergencies, seek immediate medical care.

 Diagnosis and treatment

• Blood tests to find metabolic acidosis, kidney function and osmolar gap; urine for crystals.
• Toxicology testing of the syrup and blood if contamination is suspected.
• Treatments can include antidotes that block the toxic conversion (e.g., fomepizole), aggressive supportive care, and emergency dialysis to remove toxins and correct acid–base balance.

How families and systems can prevent such tragedies?

• Avoid giving cough/cold medicines to very young children unless advised by a clinician.
• Use only licensed products bought from reputable pharmacies; check batch recalls and safety advisories.
• Regulators and manufacturers must enforce strict quality control, test raw materials, and audit suppliers.
• Hospitals and clinicians should report unusual clusters of illness quickly to public health authorities.

These deaths highlight both the vulnerability of young children and the critical importance of medicine quality and safe pediatric prescribing. Rapid clinical recognition, strong regulatory action, and public awareness are essential to prevent similar incidents in the future.