Coldrif cough syrup deaths: Could Fomepizole, a hooch-poisoning drug, be a lifesaver?

Cough syrup

A drug normally used to treat hooch poisoning has turned out to be the antidote that helped doctors counter the deadly effects of the Coldrif cough syrup tragedy, which has claimed at least 15 children’s lives in Madhya Pradesh’s Chhindwara district since August. Several others are still battling for survival.

When all standard treatments failed and children continued to die, doctors at Government Medical College and Hospital (GMCH), Nagpur, led by Dr Manish Tiwari, held scientific discussions with reputed paediatricians and decided to administer Fomepizole, a drug generally used as an antidote in confirmed or suspected cases of methanol or ethylene glycol poisoning, The Times of India reported.

Lab results from Tamil Nadu later confirmed the doctors’ suspicions, the syrup contained 48.6% diethylene glycol (DEG), an industrial chemical used in brake fluids and antifreeze, which is toxic to the kidneys, liver and nervous system.

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Can Fomepizole prove to be lifesaver?

While six children from Madhya Pradesh died of renal failure at GMCH alone when the cause was unknown, six managed to survive, but are in a critical condition. "Two have begun passing urine, but are in deep coma, while four others are still unable to pass urine. DEG concentration was 500% (48.6%) and has left them with severe brain damage too," TOI quoted Dr Tiwari as saying.

These kids were brought to Nagpur between September 26 and October 4 and by then the role of killer syrup was established.

Doctors administered Fomepizole, which prevents the toxic conversion of DEG in the body. The timely use of this drug helped prevent further deaths and stabilised some of the affected children, the doctors said.

Health authorities soon circulated this treatment protocol to private hospitals and Chhindwara’s health department, instructing them to begin Fomepizole therapy for any child showing symptoms of DEG poisoning, ideally within 18 hours of exposure. Officials confirmed that patients who received the drug early showed better recovery signs.

How the cause was found?

The breakthrough came after several false starts. When three children suddenly died within hours of admission in August, doctors at GMCH alerted the Nagpur Municipal Corporation’s Metropolitan Surveillance Unit (MSU), which coordinates directly with the National Centre for Disease Control (NCDC). A joint team of central and state experts soon arrived in Chhindwara and Nagpur to study the pattern of deaths.

Once preliminary findings ruled out common infectious diseases, doctors began searching for a common link. "Coldrif, prescribed by the same doctor to all affected children, turned out to be the culprit. Once DEG poisoning was confirmed, the picture became clear," officials said.

Renowned paediatrician Dr Anand Bhutada, director of New Era Mother and Child Hospital, said his team treated four children with the same symptoms. "Initially, we had no specific drug for the unexplained kidney failure. Hooch poisoning involves the same contaminant as DEG. After using Fomepizole, we observed gradual improvement in the children's kidney function." Three of these kids were discharged while one succumbed.

He added that while the results cannot be guaranteed, Fomepizole was the only drug that seemed to flush out the poison, along with dialysis and supportive care.