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April 15, 1998

The Haitian Diethylene Glycol Poisoning TragedyA Dark Wood Revisited

Author Affiliations

From the Program of Clinical Toxicology in the Division of General Pediatrics, Department of Medicine, Children's Hospital, the Department of Pediatrics, Harvard Medical School, and the Massachusetts Poison Control System, Boston.

JAMA. 1998;279(15):1215-1216. doi:10.1001/jama.279.15.1215

Dante Alighieri begins his masterwork poem,The Divine Comedy,1 by recounting how he came to embark on his journey through the Inferno: "In the middle of the journey of our life I found myself in a dark wood, having lost the straight path." In this issue of JAMA, O'Brien and colleagues2 take us to the dark wood of a public health disaster: the contamination of a medication, acetaminophen, with a toxic chemical, diethylene glycol (DEG), which occurred in Haiti in 1995 and 1996. Composed of 2 ethylene glycol residues joined by an ether bond, DEG has many industrial uses as a humectant, plasticizer, antifreeze, and solvent. In the confiscated medicines tested in Port-au-Prince, the median DEG concentration was 14.4%; a trace-back investigation revealed formulation of the syrups using glycerin of Chinese origin that was contaminated with 24% DEG. The somber results: at least 109 children sustained a variety of toxic effects including acute renal failure, which the case-control study results reported by O'Brien et al confirm as attributable to the DEG. Of 87 children who stayed in Haiti and were available to the researchers for follow-up, 85 died—a death toll of 98%. Of the 11 patients who were evacuated to the United States, only 8 survived.

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