Paracetamol Tragedy in Bangladesh,2009

Toxic Paracetamol kills children

Shahidul Islam Chowdhury

A section of pharmaceutical companies have been using toxic industrial chemicals in medicines, especially in Paracetamol syrup, causing deaths to a number of children and putting life of many others at risk, according to physicians and experts.
   At least eight children died of renal failure at Dhaka Shishu Hospital and Bangabandhu Sheikh Mujib Medical University Hospital in last two months as they consumed adulterated Paracetamol syrup.
   After primarily detecting a case of adulteration in Paracetamol syrup of a private pharmaceutical company, the Dhaka Shishu Hospital authorities has drawn attention of the government for necessary actions.
   Eight month old Nipa and Nishita of one-and-half-year age are among the patients undergoing treatment for renal failure at the Shishu Hospital. Their mothers told New Age that they brought the babies to the Shishu Hospital from Bancharampur upazila in Comilla as the babies stopped urinating. The babies were given Paracetamol syrup procured from local medicine shops.
   ‘Will she stay alive?’ Bina, the worried mother of Nipa, asked the attending physicians.
   At least eight more babies were admitted to the Bangabandhu Sheikh Mujib Medical University Hospital with acute renal failure.
   A senior physician of the Shishu Hospital said about 30 children had been admitted with kidney failure in last two months and five of them had died. ‘It is unusual. We generally receive less than 40 children with acute renal failure in a year and four or five of them die.’
   The physician said, ‘We initially tried to identify the causes of death of the children. The case histories of the patients prompted us to collect samples of medicines they were given for fever. We sent the samples to a laboratory, which found presence of Diethylene glycol in a Paracetamol syrup brand.’
   ‘Traces of Ethylene and Diethylene glycols were found by Gas Chromatograph test,’ read the report.
   According to the report, the names of the pharmaceutical company and its Paracetamol syrup brand begin with the letter ‘R’.
   Paracetamol is commonly used for the relief of fever, headaches, and other minor aches and pains, and administered for numerous cold and flu remedies, according to physicians. The widely known drug is frequently used without doctor’s prescription and sold even in grocery shops.
   Reza-ul Jalil, chairman of drug technology department of Dhaka University, said Diethylene glycol is unsuitable for human consumption.
   ‘It is generally used in industries including tannery. A section of small pharmaceutical companies illegally use Diethylene glycol as a component of Paracetamol and other syrups,’ he said. ‘Paracetamol toxicity is a cause for acute kidney and lever failures.’
   ‘In most of the cases, children die after taking toxic Paracetamol. Those who remain alive suffer from different health complications,’ he said expressing his surprise as the pharmaceutical companies here had not taken lesson from death of children after taking toxic Paracetamol syrup about 20 years ago.
   In Bangladesh in 1990, as many as 339 children developed acute renal failure, and most of them died, after being given Paracetamol syrup contaminated with diethylene glycol.
   In recent years, deaths from medicines adulterated with diethylene glycol were reported in South Africa, India, Nigeria, Argentina, Haiti and Panama.
   The Shishu Hospital authority informed the Directorate General of Health Services on July 16 about the test results and requested for necessary actions, director general of DGHS professor Shah Monir Hossain told New Age Monday.
   He said he had forwarded the letter of the Shishu Hospital immediately to the Drug Administration for taking action against the pharmaceutical company concerned.
   However, Drug Administration director Brigadier General Ismail Hossain told New Age Monday afternoon that his office did not get any such letter from the DGHS.
   Health minister AFM Ruhal Haque told New Age that he would hold a meeting today (Tuesday) to discuss the issue and take actions against use of toxic chemicals in medicines.

Source: www.newagebd.com/2009/jul/21/front.html#1

Date:21 july,2009

Two more babies die, death
toll rises to 23

Shahidul Islam Chowdhury

The Drug Administration on Wednesday sealed off the Rid Pharmaceuticals in Brahmanbaria as 23 children, mostly from Greater Comilla, had died of acute renal failure in two Dhaka hospitals after being administered analgesic paracetamol syrup.
   Two more children, on the other hand, died in Dhaka Shishu Hospital on Wednesday, taking the death toll to 23. All of them died of acute renal failure in two hospitals in the city after being administered paracetamol at home.
   Drug Administration assistant director Abul Khair, with the help of the local administration, sealed off the Rid Pharmaceuticals in the BSCIC Industrial Area at Nandanpur in Brahmanbaria at around 6:00pm.
   Abul Khair said the factory had been sealed off in accordance with an order of the Drug Administration director, Brigadier General Ismail Hossain.
   The company’s managing director, Mizanur Rahman, however, told reporters neither he had got any official order for the closure of the factory nor there had been any allegation against the company.
   Although the factory was closed, the authorities are yet to take any steps for the withdrawal of the paracetamol brand, which reportedly contains diethylene glycol which causes acute renal failure.
   The head of the investigation committee that was formed on Tuesday, MA Jalil, also joint secretary of the health ministry, told New Age samples of the drug had been sent to laboratory for tests.
   No order for withdrawal of the drug from the market has so far been issued, he said, adding the next action would be taken in accordance with the report of the laboratory tests.
   The factory was closed after 23 children had died of acute renal failure after being given paracetamol syrup.
   Dhaka Shishu Hospital’s director Professor AR Khan confirmed the death of the two children. ‘One of the children died Tuesday night and the other Wednesday morning,’ he told New Age.
   The deceased were eight-month-old Nipa and eighteen-month-old Nishita.
   Their mothers told New Age they had brought the babies to Shishu Hospital from Banchharampur in Comilla when they had stopped urinating after being treated with paracetamol syrup to heal the fever.
   With the death of the two babies, a total of 23 children have died of acute renal failure at Dhaka Shishu Hospital and Bangabandhu Sheikh Mujib Medical University hospital in about a month and a half.
   Professor Mohammad Hanif of Dhaka Shishu Hospital had earlier told New Age that 26 children had been admitted to the hospital with complaints of renal failure since June 1. ‘Out of them 17 children died,’ he said on Tuesday. ‘It is highly unusual that most of the children died of renal failure.’
   Professor M Moazzem Hossain of Bangabandhu Sheikh Mujib Medical University hospital said on Tuesday that eight children had been admitted to the hospital with complaints of renal failure. ‘Four of them died.’
   According to physicians of the two hospitals, the babies were given paracetamol syrup, an analgesic (pain-killer), procured from local medicine shops in their villages. Some of them also consumed vitamin syrup, they said.
   Physicians in the two hospitals, after primary investigation, suspect that the kidneys of the children collapsed as the paracetamol and vitamin syrups were contaminated with toxic chemicals.
   Shishu Hospital authorities confirmed the presence of diethylene glycol, a chemical generally used in the dyeing and tannery industries, in a particular brand of vitamin syrup, and immediately drew the attention of the government so that it can action to stop further sale of that brand.
   The government on Tuesday formed the investigation committee to find out the reasons for the recent spate of death and identify the producers of the poisonous paracetamol and vitamin syrups. The seven-member committee has been asked to submit its report in five working days. The health minister, AFM Ruhal Haque, is personally supervising the investigation.
   The BSMMU authorities on Tuesday formed an internal three-member probe body to find out the reasons for the death of four children at the nephrology department. Paediatrician Professor Shahana Akhter Rahman who was made the convener and Professor Muhammad Rafiqul Alam, chairman of the nephrology department, and Professor M Habibur Rahman, of the paediatric nephrology department, are the three members of the body. The authorities have asked the committee to submit its report within three working days.
   When asked whether the Dhaka Shishu Hospital authorities would go for further investigation, its director Professor AR Khan said they were waiting for the findings of the government’s probe body. ‘They have started working. Let us wait for their report,’ he told New Age on Wednesday.
   Paediatricians Mohammad Hanif and M Moazzem Hossain, however, advised the people not to be panicked about all the brands of these two drugs, saying that reputable pharmaceutical companies generally do not adulterate their products.
   The analgesic syrup, contaminated with diethylene glycol, injured the kidneys of some 339 children in 1990 and most of them died.
   In recent years, deaths from medicines adulterated with diethylene glycol have been reported in South Africa, India, Nigeria, Argentina, Haiti and Panama.

http://www.newagebd.com/2009/jul/23/front.html#1

Date:23 july,2009

PARACETAMOL, VITAMIN ADULTERATION Authorities start withdrawing  ‘poisonous’ syrups

Shahidul Islam Chowdhury

The authorities on Friday started withdrawing two ‘poisonous’ syrups produced by the Rid Pharmaceuticals from pharmacies in Greater Comilla and neighbouring districts after sealing off its factory in Brahmanbaria, the Drug Administration said.
   ‘The Drug Administration people have started withdrawing the syrups from the market,’ the Drug Administration director, Brigadier General M Islmail Hossain, told New Age Friday.
   ‘The Rid Pharmaceuticals management has also started withdrawing the syrups,’ he said, quoting the company’s managing director Mizanur Rahman.
   The Drug Administration sealed off the Rid Pharmaceuticals in Brahmanbaria on Wednesday as 24 children, mostly from Greater Comilla, died of acute renal failure in two Dhaka hospitals after being administered analgesic paracetamol and vitamin syrups.
   The government will decide the next steps on receiving reports of the committees formed to investigate the deaths of the children in Dhaka Shishu Hospital and Bangabandhu Sheikh Mujib Medical University Hospital that had taken place since June 1.
   According to physicians, 24 out of the 34 children admitted to the hospitals with complaints of renal failure after being administered paracetamol in remote areas in Greater Comilla, Narsingdi, Habiganj and Chittagong died. Some of them were also given vitamin syrup.
   Physicians in the two hospitals, after preliminary investigations, suspected the kidneys of the children failed as paracetamol and vitamin syrups contained toxic chemicals.
   The Shishu Hospital authorities confirmed the presence of diethylene glycol, a chemical generally used in dyeing and tannery industries, in a brand of vitamin syrup and immediately called the government’s attention to the matter so that could take action to stop further sales of the brand.
   Professor Mohammad Hanif of Dhaka Shishu Hospital on Friday said no new child patients were admitted to the hospital in five days with similar complaints. ‘It seems the guardians have stopped administering children toxic syrups.’
   The government, parliamentary standing committee on the health ministry and the BSMMU hospital authorities have formed three committees to find out what caused the deaths.
   The Drug Administration on Wednesday sealed off the Rid Pharmaceuticals in Brahmanbaria on suspicion that it was producing Temset and Ridaplex in violation of the ‘approved formulas.’
   The Rid Pharmaceuticals was producing Temset ‘syrup’ although it was allowed to produce ‘suspension,’ a senior Drug Administration official told New Age. ‘We have also found the presence of toxic diethylene glycol in Redaplex syrup in laboratory tests.’
   The BSMMU pro-vice chancellor, Professor M Moazzem Hossain, also a member on the government investigation committee, on Friday said the committee would submit a comprehensive report at the earliest.
   The analgesic syrup, containing diethylene glycol, injured the kidneys of some 339 children in 1990 and most of them died.
   In recent years, deaths from medicines adulterated with diethylene glycol have been reported in South Africa, India, Nigeria, Argentina, Haiti and Panama.

Source: www.newagebd.com/2009/jul/25/front.html#3

Date:25 july,2009