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Diethylene Glycol: Toxicity, Poisoning & Treatment

Diethylene glycol (DEG) is a chemical compound used as an industrial solvent that is highly toxic to humans and animals, capable of causing severe kidney failure.

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Things worth knowing about "Diethylene glycol"

Diethylene glycol (DEG) is a chemical compound used as an industrial solvent that is highly toxic to humans and animals, capable of causing severe kidney failure.

What is Diethylene Glycol?

Diethylene glycol (abbreviated DEG) is an organic chemical compound belonging to the glycol family. It is a colorless, odorless, slightly sweet-tasting liquid that is highly soluble in water. In industry, DEG is used as a solvent, plasticizer, antifreeze agent, and as a precursor in the manufacture of plastics and resins. However, diethylene glycol is highly toxic to humans and is strictly prohibited from use in food, pharmaceuticals, or cosmetic products.

Chemical Properties

Diethylene glycol has the chemical formula C₄H₁₀O₃ and belongs to the group of dihydric alcohols (diols). It is produced as a byproduct during the manufacture of ethylene glycol. Due to its physical similarity to harmless solvents and its mildly sweet taste, DEG has historically been fraudulently or accidentally used as a substitute for glycerin or propylene glycol in pharmaceuticals and food products, leading to serious mass poisoning disasters.

Toxicity and Mechanism of Action

Diethylene glycol is metabolized in the human body by liver enzymes. The primary toxic metabolites are 2-hydroxyethoxyacetic acid and diglycolic acid. These metabolites are mainly responsible for severe kidney damage.

Nephrotoxicity: DEG and its breakdown products directly damage the tubular cells of the kidneys, which can lead to acute kidney failure.
Neurological damage: At high doses or when treatment is delayed, both the central and peripheral nervous systems may be affected.
Metabolic acidosis: Toxic metabolites can severely disrupt the acid-base balance of the body.
Hepatotoxicity: In some cases, liver damage has also been observed.

Symptoms of Poisoning

Symptoms of diethylene glycol poisoning often appear with a latency period of hours to days and progress through several phases:

Early phase (hours after ingestion): Nausea, vomiting, abdominal pain, and drowsiness resembling alcohol intoxication.
Intermediate phase (1–3 days): Apparent improvement, while kidney damage continues to progress silently.
Late phase (from day 3–8): Acute kidney failure, reduced urine output (oliguria) or complete absence of urine (anuria), neurological deficits, impaired consciousness, and coma.

Notable Poisoning Disasters

Diethylene glycol has been implicated in several historical mass poisonings in which it was mistakenly or fraudulently used in medicines or food:

1937, USA: The so-called Sulfanilamide Elixir disaster, in which DEG was used as a solvent in a sulfonamide preparation, killed more than 100 people. This event led to the enactment of the U.S. Federal Food, Drug, and Cosmetic Act.
1985, Austria: Some wine producers added DEG to artificially sweeten wine, resulting in the international Austrian Wine Scandal.
2006, Panama: DEG-contaminated cough syrup caused the deaths of at least 78 people.
Additional cases have been reported from India, Nigeria, Haiti, and other countries, involving contaminated medications such as paracetamol syrup containing DEG.

Diagnosis

The diagnosis of DEG poisoning is based on:

Patient history and suspicion of exposure to DEG-containing products.
Laboratory findings: Elevated kidney retention parameters (creatinine, urea), metabolic acidosis with an elevated anion gap, and detection of DEG or its metabolites in blood or urine using gas chromatography-mass spectrometry (GC-MS).
Imaging and clinical assessment to evaluate the extent of kidney failure.

Treatment

DEG poisoning requires immediate intensive medical care:

Gastric lavage and activated charcoal: If the patient presents shortly after ingestion.
Hemodialysis: The most important treatment measure to remove DEG and its toxic metabolites from the blood and to manage kidney failure.
Fomepizole: An alcohol dehydrogenase inhibitor that can slow the formation of toxic metabolites. Also used in ethylene glycol poisoning.
Supportive intensive care: Fluid administration, correction of acid-base imbalance, and continuous monitoring of kidney function.

Occurrence and Prevention

Diethylene glycol is not an approved substance in food, pharmaceuticals, or cosmetics in the European Union or the United States. Regulatory authorities such as the European Medicines Agency (EMA) and the U.S. Food and Drug Administration (FDA) strictly monitor the purity of pharmaceutical excipients to prevent DEG contamination. Consumers should exercise particular caution when purchasing medicines or dietary supplements from unknown or unregulated sources.

References

World Health Organization (WHO): Safety of medicines – A guide to detecting and reporting adverse drug reactions. WHO/EDM/QSM/2002.2. Geneva, 2002.
Schep LJ, Slaughter RJ, Temple WA, Beasley DM: Diethylene glycol poisoning. Clinical Toxicology, 2009; 47(6): 525–535. DOI: 10.1080/15563650903086444.
European Medicines Agency (EMA): Guideline on excipients in the dossier for application for marketing authorisation of a medicinal product. EMA/CHMP/QWP/396951/2006. London, 2007.

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