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Published:
Journal of Analytical Toxicology,
ISSN 0146-4760,
Volume 31, Number 6, July/August,
pp.295-303
Identification and Quantification of Diethylene
Glycol in Pharmaceuticals Implicated in Poisoning Epidemics:
An Historical Laboratory Perspective
Dana B. Barr, John R. Barr, Gayanga Weerasekera,
Jacob Wamsley, Suzanne R. Kalb, Andreas Sjödin, Joshua G.
Schier, E. Danielle Rentz, Lauren Lewis, Carol Rubin, Larry L.
Needham, Robert L. Jones, and Eric J. Sampson
National Center of Environmental Health, Centers for Disease Control
and Prevention, Atlanta, Georgia 30341
Over
the last several decades, mass poisonings of diethylene glycol
(DEG), usually ingested as an unintended component of pharmaceutical
preparations, have occurred. In order to promptly halt the
rise in deaths due to ingestion of these pharmaceuticals, laboratory
analysis has often been employed to identify and quantify the
etiologic agent after the medications have been tentatively
implicated. Over the past 15 years, the Centers for Disease
Control and Prevention has been involved in identifying DEG
in implicated pharmaceutical products during three poisoning
epidemics that occurred in Nigeria (1990), Haiti (1995), and,
most recently, in Panama (2006). In each case, the timeliness
of the identification was paramount in reducing the mortality
involved in these mass poisonings. Using state-of-the-art analytical
technology, we were able to provide initial identification
of DEG within 24 h of receiving samples for each epidemic,
allowing a timely public health response. However, over the
past 15 years, the analytical instrumentation available and
the laboratory responses undertaken have changed. In addition,
the type of information and the degree of confirmation of results
requested during each epidemic varied based upon the number
of individuals involved and the political tenor involved with
the outbreak. We describe our historical approach to identifying
and quantifying DEG during each of these outbreaks. Furthermore,
the reoccurrence of outbreaks has prompted us to establish
standard technology to use in potential future outbreaks to
allow an even more timely response. This methodology includes
the development of biomarkers of DEG exposure, which would
be extremely useful in instances where pharmaceuticals are
not clearly implicated.
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