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Published Date: 2012-11-28 09:27:22
Subject: PRO/EDR> Cough syrup, adulterated - Pakistan: (PB) fatalities, RFI
Archive Number: 20121128.1427296
COUGH SYRUP, ADULTERATED - PAKISTAN: (PUNJAB) FATALITIES, REQUEST FOR INFORMATION
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A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Tue 27 Nov 2012
Source: La Estrella, Xinhua News Agency report [in Spanish, trans. Mod.JG, edited]
According to a local police report, during the past 2 days at least 13 people died and several more are in critical condition after the ingestion of a toxic cough syrup in Lahore, a city located in east Pakistan.
Police officers stated that last Saturday night [Sun 25 Nov 2012] more than 20 [drug] addicts drank a locally manufactured cough syrup in order to get drunk, but a few minutes after the ingestion they started getting quite sick. 5 people died on the site and the remaining were transported to the Mayo state hospital, where physicians interviewed declared that the syrup was an adulterated product that caused serous damage to internal organs.
On 25 Nov 2012, 8 additional people died, and the remaining 7 to 10 patients are in critical condition, according to the local hospital sources.
The product costs 40 Pakistan Rupees (USD 0.42), and is available in many drugstores in the city.
Mr Shahbaz Sharif, chief minister of Punjab, took immediate action and ordered the police to shut down the manufacturing facility of the suspected product, as well as the drugstores that sold it. He also appointed an investigation committee and demanded that a report be produced in the next 72 hours.
The owners of the drugstores involved were arrested and samples of the toxic preparation were sent to specialized laboratories for testing.
Counterfeit medications represent good business in Pakistan given that many local pharmaceutical companies are involved.
In the past, the Government arrested some pharmacists for manufacturing low quality drugs, but because of gaps in the legal system, none of them received adequate punishment.
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[There is not enough information to do more than speculate about the cough syrup. Some cough syrups contain alcohol, while others may contain codeine as a cough suppressant. If these individuals were imbibing the cheap cough syrup in place of alcohol, then it may have contained alcohol or even methanol. Methanol can be quite toxic, and those surviving may be blind. However, this product may have had methanol and perhaps codeine in it that caused a lethal mixture. There are likely many mixtures that could have been in the syrup.
Diethylene glycol (DEG) has been documented in cough syrup in Panama in 2006 and 2007. In Gosselin et al (reference 1) there is mention that a single oral dose of between 0.5 to 5 mg/kg is lethal to humans. There are no clinical signs mentioned in the article but DEG tends to produce severe gastrointestinal signs, cramping, vomiting, and diarrhea, and back pain in the region of the kidneys. DEG can cause kidney failure and the dose to produce death is relatively small as mentioned earlier in this paragraph.
Reference
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1. Gosselin RE, Hodge HC, Smith RP, and Gleason MN: Clinical Toxicology of Commercial Products. 4th ed. Baltimore: Williams and Wilkins, 1976., p. II-119.
While we are not open to speculation regarding possible other lethal combinations, we are interested in an official report of what was in the cough syrup and the outcome of the investigation. - Mod.TG]
Subject: PRO/EDR> Cough syrup, adulterated - Pakistan: (PB) fatalities, RFI
Archive Number: 20121128.1427296
COUGH SYRUP, ADULTERATED - PAKISTAN: (PUNJAB) FATALITIES, REQUEST FOR INFORMATION
************************************************** *******************************
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Tue 27 Nov 2012
Source: La Estrella, Xinhua News Agency report [in Spanish, trans. Mod.JG, edited]
According to a local police report, during the past 2 days at least 13 people died and several more are in critical condition after the ingestion of a toxic cough syrup in Lahore, a city located in east Pakistan.
Police officers stated that last Saturday night [Sun 25 Nov 2012] more than 20 [drug] addicts drank a locally manufactured cough syrup in order to get drunk, but a few minutes after the ingestion they started getting quite sick. 5 people died on the site and the remaining were transported to the Mayo state hospital, where physicians interviewed declared that the syrup was an adulterated product that caused serous damage to internal organs.
On 25 Nov 2012, 8 additional people died, and the remaining 7 to 10 patients are in critical condition, according to the local hospital sources.
The product costs 40 Pakistan Rupees (USD 0.42), and is available in many drugstores in the city.
Mr Shahbaz Sharif, chief minister of Punjab, took immediate action and ordered the police to shut down the manufacturing facility of the suspected product, as well as the drugstores that sold it. He also appointed an investigation committee and demanded that a report be produced in the next 72 hours.
The owners of the drugstores involved were arrested and samples of the toxic preparation were sent to specialized laboratories for testing.
Counterfeit medications represent good business in Pakistan given that many local pharmaceutical companies are involved.
In the past, the Government arrested some pharmacists for manufacturing low quality drugs, but because of gaps in the legal system, none of them received adequate punishment.
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[There is not enough information to do more than speculate about the cough syrup. Some cough syrups contain alcohol, while others may contain codeine as a cough suppressant. If these individuals were imbibing the cheap cough syrup in place of alcohol, then it may have contained alcohol or even methanol. Methanol can be quite toxic, and those surviving may be blind. However, this product may have had methanol and perhaps codeine in it that caused a lethal mixture. There are likely many mixtures that could have been in the syrup.
Diethylene glycol (DEG) has been documented in cough syrup in Panama in 2006 and 2007. In Gosselin et al (reference 1) there is mention that a single oral dose of between 0.5 to 5 mg/kg is lethal to humans. There are no clinical signs mentioned in the article but DEG tends to produce severe gastrointestinal signs, cramping, vomiting, and diarrhea, and back pain in the region of the kidneys. DEG can cause kidney failure and the dose to produce death is relatively small as mentioned earlier in this paragraph.
Reference
---------
1. Gosselin RE, Hodge HC, Smith RP, and Gleason MN: Clinical Toxicology of Commercial Products. 4th ed. Baltimore: Williams and Wilkins, 1976., p. II-119.
While we are not open to speculation regarding possible other lethal combinations, we are interested in an official report of what was in the cough syrup and the outcome of the investigation. - Mod.TG]