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Effects of diethylene glycol contamination of pharmaceutical products on unexplained acute kidney injury in children: a systematic review

Clin Exp Pediatr > Accepted Articles
DOI: https://doi.org/10.3345/cep.2023.01039    [Accepted]
Published online January 4, 2024.
Effects of diethylene glycol contamination of pharmaceutical products on unexplained acute kidney injury in children: a systematic review
Sani Soleman1  , Muhammad Adnan2  , Hilmi Sudiarto2  , Satria Mahathma2  , Alya Tazkia2  , Hana Firdaus2  , Alfreda Khotijah2  , Miranti Pramaningtyas3  , Emi Choironi4 
1Department of Public Health, Faculty of Medicine, Universitas Islam Indonesia, Yogyakarta, Indonesia
2Faculty of Medicine, Universitas Islam Indonesia, Yogyakarta, Indonesia
3Department of Physiology, Faculty of Medicine, Universitas Islam Indonesia, Yogyakarta, Indonesia
4Department of Pediatrics, Faculty of Medicine, Universitas Islam Indonesia, Yogyakarta, Indonesia
Correspondence: 
Sani Soleman, Tel: +6274 898444, Fax: +6274 898444, Email: sani.rachman@uii.ac.id
Received: 2 August 2023   • Revised: 10 October 2023   • Accepted: 21 October 2023
Abstract
Unexplained acute kidney injury (AKI) in children owing to diethylene glycol (DEG) contamination during drug production has gained attention in recent years. This qualitative study investigated the effects of DEG exposure on the incidence of unknown AKI in children. A systematic review following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines was proposed to search for studies using predefined search terms in the PubMed, EBSCO, and Web of Science databases without publication date restrictions. The inclusion criteria are observational study, case study, case report, and case series design; and having provided accurate data for DEG poisoning and AKI diagnosis in children. All authors performed the study screening, data extraction, and data synthesis processes. Consensus was reached by mutual agreement. The data synthesis was conducted according to the DEG and unexplained AKI in children by examining the statistical data using Microsoft Excel 2017 and storing the data using the cloud service of Universitas Islam Indonesia. Of the 115 included studies, 21 met the inclusion criteria, including 2 case-control studies, 1 cross-sectional study, 4 case studies, and 14 case reports. DEG-contaminated paracetamol caused unexplained AKI in children. Other drugs including cough expectorants, antihistamines, and sedatives were administered. Chemicals other than DEG, such as propylene glycol and ethylene glycol, also induce AKI owing to overprescription and unintentional exposure. A recent epidemic of unexplained AKI showed contaminated paracetamol as the poisoning agent regardless of formula.
Key Words: Diethylene glycol, Contaminated paracetamol, Unexplained AKI, Child


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