Kidney Diseases & A Longer Struggle: How Life For Children Who Survived Toxic Cough Syrups Could Be

Last Updated:October 13, 2025, 10:05 IST

Apart from requiring long-term renal monitoring and follow-up care, the need for dialysis support if kidney function worsens could also occur.

An elderly woman looks at a bottle of Coldrif cough syrup, in Betul, Madhya Pradesh. (IMAGE: PTI)

Weeks after several Indian-made cough syrups were found to contain dangerously high levels of diethylene glycol (DEG), the tragedy continues to unfold beyond the headlines. While some children did not survive, several others — especially in Madhya Pradesh — remain unwell and may struggle long to return to normalcy. There is no clear national estimate yet of how many remain affected, but doctors say the road to recovery will be long and uncertain for many families.

These young survivors will continue to battle the lingering effects of toxic organ damage — their kidneys weakened, nervous systems compromised, and growth trajectories disrupted by the chemical that entered their bloodstream disguised as medicine.

“Children who survive DEG poisoning may suffer from chronic kidney disease or reduced kidney function, persistent neurological deficits like weakness or cognitive difficulties, and growth delays," said Dr Madhuri Jaitley, associate consultant nephrologist at Paras Health, Gurugram. “Long-term follow-up with kidney and nerve specialists is essential for such children."

Apart from requiring long-term renal monitoring and follow-up care, the need for dialysis support if kidney function worsens could also occur.

“Once DEG enters a child’s bloodstream, it starts forming those crystals that choke the kidneys from inside," explained Dr Ishwar Gilada, infectious disease expert and president emeritus of the AIDS Society of India.

“What begins as just vomiting or drowsiness can very quickly turn fatal. Within six to twelve hours of consuming a DEG-laced syrup, the toxins begin to circulate through the bloodstream, setting off a cascade of damage to vital organs."

For many families, survival is only the beginning of a longer struggle — one involving lifelong medical care, developmental delays, and emotional trauma.

How the poisoning began?

The poisoning begins deceptively. A child may first show vague signs such as vomiting, abdominal pain, or unusual sleepiness — symptoms that resemble a common viral infection. But within hours, the toxins start to build up in the bloodstream. As DEG is metabolised inside the liver, it transforms into compounds that begin to damage vital organs. “As toxicity progresses, symptoms may include decreased urine output, tremors, seizures, or signs of kidney failure. Early recognition is important," warned Jaitley.

Diethylene glycol (DEG) is a highly toxic industrial chemical used in antifreeze, brake fluids, and paints — never meant for human consumption. Yet, it has repeatedly found its way into medicines due to poor manufacturing oversight or deliberate adulteration, with devastating consequences.

“Ingested DEG is rapidly absorbed and metabolised in the liver into toxic compounds, primarily diglycolic acid," said Jaitley. “These metabolites are highly nephrotoxic and neurotoxic, causing direct damage to the kidneys, liver, and nervous system."

Inside the body, DEG also transforms into oxalic acid, which binds with calcium to form calcium oxalate crystals. “The DEG is a very toxic chemical, can cause kidney damage by deposition of calcium oxalate crystals. Calcium oxalate stones are the most common kidney stones," Gilada said.

“DEG is metabolised into oxalic acid, which combines with calcium to form the toxic crystals of calcium oxalate," he said, adding that these crystals block the kidney’s filtering structures, cutting off its ability to flush out toxins, and causing rapid renal failure.

A Tragedy That Could Have Been Prevented

In recent weeks, India has been rocked by revelations that three cough syrups — Coldrif, Respifresh TR, and ReLife — contained dangerously high levels of DEG, with laboratory tests showing contamination levels of up to 48.6 per cent, nearly 500 times the acceptable limit. The syrups, produced by Sresan Pharmaceuticals in Tamil Nadu, have been linked to the deaths of at least 17 children due to acute kidney failure.

Following public outrage, the Union Health Ministry and Central Drugs Standard Control Organisation (CDSCO) have launched nationwide raids and audits on cough syrup manufacturers to trace other potentially contaminated batches.

“The progression of diethylene glycol (DEG) poisoning is alarmingly swift and often deceptive," said Dr Shashank Trivedi, senior consultant, paediatrics, Apollo Spectra Hospital, Kanpur. “Mild symptoms such as nausea or abdominal pain can appear within hours, but within one to three days, the toxin severely begins to damage the kidneys, leading to complete renal shutdown."

He stressed that the first 24 hours are critical. “Early dialysis and antidotes like fomepizole can save lives," he said. “Unfortunately, even survivors may face long-term complications such as chronic kidney disease, neurological deficits, and growth delays."

The Smallest Bodies, the Heaviest Burden

Children are far more vulnerable to DEG poisoning because of their lower body mass and immature liver and kidney function. Dr Tanya Chaturvedi, consultant paediatrics at Regency Hospital, Gorakhpur, explained, “The compound is absorbed quickly and metabolised into highly toxic intermediates which severely disrupts the acid-base balance of the body. These toxins particularly damage the kidney tubular structures, leading to acute renal failure within hours or days."

Because DEG mimics ethanol, it interferes with normal biochemical pathways. “It triggers multi-organ toxicity causing impact on the brain, liver, and pancreas," said Dr Chaturvedi. “Children are especially vulnerable due to low body mass and limited detoxification capacity, making even small doses potentially fatal."

Each case of DEG poisoning is more than a statistic; it is a story of a child robbed of health by systemic negligence.

Himani Chandna

Himani Chandna, Senior Associate Editor at CNN News18, specialises in healthcare and pharmaceuticals. With firsthand insights into India's COVID-19 battle, she brings a seasoned perspective. She is particular...Read More

Himani Chandna, Senior Associate Editor at CNN News18, specialises in healthcare and pharmaceuticals. With firsthand insights into India's COVID-19 battle, she brings a seasoned perspective. She is particular...

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