{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T14:38:57Z","timestamp":1792075137170,"version":"4.4.0"},"reference-count":22,"publisher":"BMJ","issue":"6997","license":[{"start":{"date-parts":[[1995,7,8]],"date-time":"1995-07-08T00:00:00Z","timestamp":805161600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"accepted":{"date-parts":[[1995,4,13]]},"published-print":{"date-parts":[[1995,7,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:bold>Objective<\/jats:bold>\n                    : To determine the cause of a large increase in the number of children with unexplained renal failure.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Design<\/jats:bold>\n                    : Case-control study.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Setting<\/jats:bold>\n                    : Children's hospital in Dhaka, Bangladesh.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Subjects<\/jats:bold>\n                    : Cases were all 339 children with initially unexplained renal failure; controls were 90 children with cause of renal failure identified; all were admitted to hospital during 35 months after January 1990.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Main outcome measures<\/jats:bold>\n                    : Differences between the case and control patients in clinical and histological features and outcome; toxicological examination of 69 bottles of paracetamol from patients and pharmacies.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results<\/jats:bold>\n                    : Compared with children with an identified cause for their renal failure, children with initially unexplained renal failure were significantly (P&lt;0.05) more likely to have hepatomegaly (58% v 33%), oedema (37% v 20%), and hypertension (58% v 23%); to have a higher serum creatinine concentration (mean 519 \u00b5mol\/l v 347 \u00b5mol\/l) and lower serum bicarbonate concentration (10.1 mmol\/l v 12.4 mmol\/l); to have been given a drug for fever (91% v 31%); to have ingested a brand of paracetamol shown to contain diethylene glycol (20% v 0%); and to have died in hospital (70% v 33%). Diethylene glycol was identified in 19 bottles of paracetamol, from 7 of 28 brands tested. In the 12 months after a government ban on the sale of paracetamol elixir, new cases of renal failure decreased by 54%, and cases of unexplained renal failure decreased by 84%.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion<\/jats:bold>\n                    : Paracetamol elixirs with diethylene glycol as a diluent were responsible for a large outbreak of fatal renal failure in Bangladesh.\n                  <\/jats:p>","DOI":"10.1136\/bmj.311.6997.88","type":"journal-article","created":{"date-parts":[[2011,10,27]],"date-time":"2011-10-27T19:35:42Z","timestamp":1319744142000},"page":"88-91","source":"Crossref","is-referenced-by-count":105,"title":["Fatal renal failure caused by diethylene glycol in paracetamol elixir: the Bangladesh epidemic"],"prefix":"10.1136","volume":"311","author":[{"given":"Mohammed","family":"Hanif","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M Reaz","family":"Mobarak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Ronan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilruba","family":"Rahman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"John J","family":"Donovan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael L","family":"Bennish","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1995,7,8]]},"reference":[{"key":"2025122511123987000_311.6997.88.1","unstructured":"Windholz M Budavari S Blumetti RF Otterbein ES eds. 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Geneva: World Health Organisation, 1981."},{"issue":"suppl","key":"2025122511123987000_311.6997.88.14","first-page":"803","volume":"59","year":"1977","journal-title":"Pediatr"},{"key":"2025122511123987000_311.6997.88.15","unstructured":"People's Republic of Bangladesh, Director of Drug Administration . Memorandum randum no. VA\/37\u201302\/92\/45 January 3, 1993. Daily Inquilab 1993 January 6."},{"key":"2025122511123987000_311.6997.88.16","unstructured":"Roy SK . Drug testing laboratory, Dhaka, Bangladesh: assignment report. Dhaka: World Health Organisation, 1993. (SEA\/Drugs\/98. World Health Organisation project BAN DSE 001.)"},{"key":"2025122511123987000_311.6997.88.17","unstructured":"Grant JP . The state of the world's children 1994. Oxford: Oxford University Press, 1994:64."},{"key":"2025122511123987000_311.6997.88.18","unstructured":"Chetley A . From policy to practice. The future of the Bangladesh national drug policy. Penang, Malaysia: International Organisation of Consumers' Unions, 1992: 53\u20134, 68\u20139."},{"key":"2025122511123987000_311.6997.88.19","unstructured":"Tiranti DJ . Essential drugs: the Bangladesh example\u2013four years on. Oxford: International Organisation of Consumers' Unions, New Internationalist Publications, 1986:11."},{"key":"2025122511123987000_311.6997.88.20","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/9.2.130"},{"issue":"suppl II","key":"2025122511123987000_311.6997.88.21","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/0895-4356(91)90108-L","article-title":"Production and marketing of drugs in Brazil.","volume":"44","author":"Castelo","year":"1991","journal-title":"J Clin Epidemiol"},{"key":"2025122511123987000_311.6997.88.22","unstructured":"The use of essential drugs . Model list of essential drugs (seventh list): fifth report of the WHO expert committee. Geneva: World Health Organisation, 1992:22. 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