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Coldrif cold syrup is a medication commonly used to relieve symptoms of the common cold, such as cough , congestion and throat irritation however, recent investigations have revealed contamination in certain batches with diethylene glycol ( DEG ), a poisonous chemical used in industrial applications like antifreeze and brake fluids, not meant for pharmaceutical use. They are known to cause acute kidney failure, nervous system complications and in severe cases, death, particularly in children .

This contamination has been linked to the deaths of several children in Indian states of Madhya Pradesh and Rajasthan due to acute kidney failure raising concerns over safety in India. Some batches of cough syrups were found to have as high as 48% of DEG. This has highlighted serious gaps in pharmaceutical quality control, manufacturing oversight and regulatory enforcement. World Health Organization (WHO) also expressed serious concern about regulatory gaps enabling harmful products to enter the market, underscoring the global nature of the crisis and the need for better controls.

According to a 2024 study published in Clinical and Experimental Pediatrics, DEG-contaminated products have repeatedly been associated with outbreaks of acute kidney injury in children. Review of outbreaks and clinical consequences of DEG contamination, documenting renal failure and high child mortality in past incidents, support the need for urgent medical evaluation after exposure.

Recent tragic incidents in India, involving contaminated cough syrup s containing toxic chemicals like diethylene glycol (DEG), have elevated concerns around paediatric cough syrup use. A critical 2025 study reported in a blog by the Odisha government health initiative describes how cough syrups contaminated with high concentrations of diethylene glycol caused acute kidney failure and deaths in children under six in Madhya Pradesh and Rajasthan. The syrup named Coldrif contained 48.6% DEG, an industrial solvent known to be highly toxic when ingested. The Indian Council of Medical Research (ICMR) and Directorate General of Health Services (DGHS) issued advisories banning cough syrup use in children under four and urged strict rationing and clinical evaluation for older children.

The Ministry of Health and ICMR advisory (2025) states "most paediatric coughs are self-limiting" and urges "non-pharmacological methods as the first-line approach," recommending against cough syrup use for under fours due to safety concerns and lack of efficacy evidence. The WHO (2025) calls out "serious regulatory shortcomings" exposing children to contaminated medicines and recommends enhanced pharmaceutical oversight.

Practical steps parents can follow to protect childrenIn an interview with the Times of India, Dr Aakashneel Bhattacharya, Consultant – Infectious Diseases at Paras Health in Gurugram , shared, "It is advised to recommend safer, non-toxic alternatives that can effectively manage cold symptoms without the risks associated with unregulated syrups. For nasal congestion, saline nasal drops are a gentle and effective option, particularly for infants and young children, as they help clear nasal passages and improve breathing without side effects."

He recommended, "Steam inhalation, under adult supervision, can provide relief by loosening mucus and soothing irritated airways. Ensuring adequate fluid intake such as warm water, soups, or herbal teas helps keep the throat moist, reduces irritation and supports overall recovery by preventing dehydration. For managing fever or discomfort, age-appropriate doses of paracetamol (acetaminophen) are widely regarded as safe when administered correctly under medical guidance."

Stop using suspect syrups; trace DEG toxicity - As per a 2023 study, Catastrophic Diethylene Glycol Poisoning in Children, the most prominent clinical manifestation of DEG poisoning is nephrotoxicity (AKI and anion gap metabolic acidosis). The evidence shows that DEG causes acute kidney injury. If a cough syrup brand is implicated or under recall, stop using it immediately. Be alert to signs of renal injury (reduced urination, swelling, lethargy) and seek urgent medical care if they appear.

Be especially vigilant for unexplained acute kidney injury (AKI) - Another 2023 study, Effects of diethylene glycol contamination of pharmaceuticals, revealed that DEG-contaminated paracetamol causes unexplained AKI in children. Cough expectorants, antihistamines, and sedatives were administered in other cases. Some reports show cough syrups among drugs contaminated with DEG leading to AKI. If your child develops unexplained kidney symptoms after taking any medicine, treat it as a medical emergency even if the medicine isn’t on a recall list.

Use saline nasal irrigation (or drops) for congestion relief - Saline nasal drops or nasal irrigation are safe and effective for infants and young children, or so randomised trials and systematic reviews indicate. Studies assert that saline nasal irrigation or isotonic saline drops help clear nasal congestion in infants and young children and are safe when used correctly. It is a first-line, non-drug measure for stuffy noses. Use manufacturer instructions or paediatric guidance for volume and technique. A 2024 review, Nasal Irrigation With Saline Solution for Pediatric Acute Upper Respiratory Tract Infections, confirmed that saline nasal irrigation significantly alleviates symptoms such as nasal congestion, rhinorrhea and postnasal drip with minimal adverse effects. Another 2006 corroborating trial in JAMA Otolaryngology, found that children in the saline group showed faster resolution of nasal symptoms during acute illness with fewer illness days, school absences and complications. The researchers noted that using saline (isotonic) nasal drops or irrigation is a safe way to reduce nasal congestion in children, thus reducing reliance on symptomatic syrups during the crisis.

Avoid steam inhalation for young children - Instead of direct steam, use safer humidifiers or maintain ambient humidity. Steam tents or over-boiling water risks burns especially in toddlers. Medical safety reviews caution that steam therapy in children has been associated with scald injuries when used incorrectly (burn literature, clinical reviews). As per the general paediatric guidance and clinical practice, keeping a child well hydrated with warm fluids helps thin mucus and soothes sore throats. Humidifiers or cool-mist vaporisers (kept clean) help ease breathing but hot steam over a pan is not recommended for young children due to burn risk.

Use age- and weight-based acetaminophen only when needed - A 1998 study in JAMA Network identified DEG-contaminated acetaminophen syrup as the cause of a large outbreak of acute renal failure deaths among children in Haiti. Since contaminated medicinal syrups (including acetaminophen ones) have historically been a vector for DEG poisoning, parents should be extra cautious. Use only pharmaceutical formulations verified safe, at correct doses and avoid multi-ingredient syrups. Prefer plain acetaminophen when needed, under medical supervision. Use acetaminophen only at recommended, weight-based doses (consult dosing charts or your paediatrician). Overdosing on acetaminophen is dangerous; follow AAP or local paediatric society dosing charts. If in doubt, call poison control before administering.

Be prepared for antidote/clinical treatment (if exposure suspected) - A recent 2025 study in BMC Pediatrics revealed that ethylene and diethylene glycol poisoning is a life-threatening condition that requires prompt and accurate diagnosis. Early detection is crucial, given its high morbidity and mortality rates when left untreated.” If poisoning is suspected or confirmed, clinicians may use fomepizole (an antidote), supportive care and dialysis. What matters most is early medical contact as this is not a situation for home remedies.

Doctors strongly advise against self-medicating children with over-the-counter cold syrups, especially those not specifically prescribed, as the risks may outweigh the benefits.

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