Medication-associated diethylene glycol mass poisoning: a review and discussion on the origin of contamination.

Diethylene glycol (DEG), an extremely toxic chemical, has been implicated as the etiologic agent in at least 12 medication-associated mass poisonings over the last 70 years. Why DEG mass poisonings occur remains unclear. Most reports do not contain detailed reports of trace-back investigations into the etiology. The authors, therefore, conducted a systematic literature review on potential etiologies of these mass poisonings. The current available evidence suggests that substitution of DEG or DEG-containing compounds for pharmaceutical ingredients results from: (1) deception as to the true nature of certain ingredients by persons at some point in the pharmaceutical manufacturing process, and (2) failure to adhere to standardized quality control procedures in manufacturing pharmaceutical products intended for consumers. We discuss existing guidelines and new recommendations for prevention of these incidents.

Use of lead isotope ratios to identify sources of lead exposure in Alaska Natives.

OBJECTIVES: Although banned nationwide for waterfowl hunting, lead shot is still used for hunting in regions of Alaska. Consumption of birds hunted with lead shot may be a route of human lead exposure in susceptible populations. The Centers for Disease Control and Prevention (CDC) and Alaskan health officials conducted a cross-sectional exposure assessment and used isotope ratios (IR) to test that assumption. STUDY DESIGN: Cross-sectional exposure assessment study. METHODS: We compared isotopic profiles of blood lead in Alaska Native women from Bethel (n = 10) and Barrow (n = 10) to lead shot samples purchased from the respective regions. To evaluate the source of lead for the buckshot, we evaluated IR profiles for lead mineral and ore from a smelter in Torreon, Mexico, a suspected source of origin for the lead. RESULTS: The lead IRs for the blood lead differed significantly from the lead shot IRs (p < 0.001); thus, lead shot is unlikely to be the sole source of lead exposure of public health significance in participants of this study. Overlap in IRs for the lead shot and blood lead existed for 6 (30%) of the women from Bethel and Barrow; however, no correlation was noted between lead levels and the IRs for the blood lead. IR profiles for lead mineral and ore from Mexico were substantially different from the IRs of lead shot from Alaska, confirming that buckshot in this study is unlikely to originate from the Mexican smelter. CONCLUSIONS: Lead shot from the manufacturer in this study does not appear to be the sole source of lead exposure in most participants; nonetheless, lead shot could yet be a potential source of exposure in some populations, possibly those whose diet consists of game hunted with lead shot.

Use of isotope ratios to identify sources contributing to pediatric lead poisoning in Peru.

In 1998, a school-based blood lead level (BLL) survey of 2,510 children, conducted in Lima and Callao, Peru, revealed elevated BLLs in children from 2 Callao schools (mean BLL = 25.6 microg/dl; n = 314) and in children from Callao overall (mean BLL = 15.2 microg/dl; n = 898), compared with children from Lima (mean BLL = 7.1 microg/dl; n = 1,612). Public health officials at Peru's Direccion General de Salud Ambiental (DIGESA) hypothesized that a possible source of the elevated pediatric BLLs observed in Callao was a large depository near the port where mineral concentrates are stored prior to shipment. The U.S. Centers for Disease Control and Prevention worked with DIGESA to identify source(s) that contributed to the pediatric lead poisonings by comparing isotopic profiles of lead in blood, mineral, gasoline, and air filter samples. The lead isotope ratio (IR) observed in mineral samples from the depository in Callao differed from those in gasoline samples from Lima and Callao. The blood lead IRs of children living near the depository were similar to the IRs of the mineral samples and different from the IRs of the gasoline samples, suggesting that lead from the depository-and not gasoline-was the primary source of lead in these children. Lead IR analysis of regional air filter samples supported these findings.