[3] In personal care products (e.g. skin cream and lotions and deodorants), DEG is often replaced by selected diethylene glycol ethers.

Rat models suggest that DEG is metabolized in the liver by enzyme NAD-dependent alcohol dehydrogenase (ADH) to a hydrogen ion, NADH, and 2-hydroxyethoxyacetaldehyde (C4H8O3).

As a consequence, the weak acid HEAA and its metabolites may cause renal delay, leading to metabolic acidosis and further liver and kidney damage.

When 105 people died in 15 states during the months of September and October, the trail led back to the elixir, and the toxic potential of this chemical was revealed.

[25] This law, though extensively amended in subsequent years, remains the central foundation of FDA regulatory authority to the present day.

[26] In Cape Town, South Africa, seven children developed vomiting, diarrhea, and dehydration, and died of kidney failure after administration of over-the-counter sedatives.

Postmortem examination revealed damage in the kidneys and liver, and laboratory testing found DEG instead of propylene glycol in the sedatives.

In November, The New York Times published a wine recall that the Federal Government released after the Bureau of Alcohol, Tobacco and Firearms tested 1,000 bottles.

[32] The next year, an Austrian electric power plant (Österreichische Draukraftwerke) in Carinthia announced that technicians developed a way to produce energy through burning 30 million liters of contaminated wine.

It was assumed that DEG was used as a substitute of propylene glycol, and this incident encouraged the Nigerian government to develop pharmaceutical quality control guidelines.

[37] A propolis syrup manufactured by Huilen Laboratories in Buenos Aires, Argentina, contained between 24 and 66.5% DEG, and caused the death of 29 people.

The factory of the medication manufacturer, Pharval, was subsequently investigated by Dr. Joel Selanikio (also of CDC, and an Epidemic Intelligence Service classmate of Katherine O'Brien).

[43] As a result of the case-control findings, and subsequent investigation at the factory, public warnings were issued by the Ministry of Health and bottles of the two medications were taken from pharmacy shelves and destroyed.

[44] Ending June 1996, the FDA had discovered counterfeit glycerin traced back to Chemical Trading and Consulting (a German broker), which bought 72 barrels of the syrup from Vos B.V., a Dutch company.

In July 1996, the American Embassy in China contacted Sinochem and requested a list of Chinese glycerin makers, but the company refused to reveal the names.

One year and a half after the FDA began to trace the poisonous shipments, an inspector, Ted Sze, finally visited the Tianhong Fine Chemicals Factory in Dalian, northeastern China.

[35] When a patient admitted for a heart attack developed the mysterious illness at the hospital, Dr. Nestor Sosa, an infectious disease specialist, analyzed the medical record.

When urine analyses for a series of metals, pesticides or their metabolites resulted negative, CDC scientists recalled the Nigeria and Haiti incidents.

[35] The Panamanian Government made a nationwide campaign, collecting around 6,000 bottles of cough syrup and three other products with the tainted glycerin manufactured by Social Security Laboratories.

The fiscal attorney urged affected citizens to approach the Public Ministry to update the official legal file and for further medical analysis.

[52] Panama's case made CDC set standardized methodology for DEG identification, hoping to have more timely response in future events.

In fact, the company bought the product in China and had already re-exported toothpaste to Costa Rica, Dominican Republic and Haiti, making Panama kick off a local warning.

[65] Soon, other countries also recalling Chinese-made toothpaste were Belize, Canada, Mozambique, Saudi Arabia, New Zealand, Spain, Italy, Japan, and Ireland, plus an Indianapolis, Indiana US hotel-supplier that distributed Chinese toothpaste in Barbados, Belgium, Bermuda, Britain, Canada, Dominican Republic, France, Germany, Ireland, Italy, Mexico, Spain, Switzerland, Turks and Caicos, the United Arab Emirates and United States.

[68][69] The Nigerian government traced the diethylene glycol to an unlicensed chemical dealer in Lagos, who sold it to a local pharmaceutical manufacturer.

[70][71][72] In December 2019, some people in the city of Belo Horizonte, initially all from the same neighbourhood, started having symptoms such as nausea, vomiting, abdominal pain, acute kidney failure, facial nerve paralysis, blurred vision, temporary blindness and sensory changes.

[73] On 9 January 2020, a police report indicated quantities of diethylene glycol in one brand of beer from the small upscale brewery Backer that could have poisoned 18 people in Belo Horizonte and other cities in Minas Gerais state.

[74][75] On 9 June, the police indicted 11 people, including brewery owners and employees, for manslaughter, unintentional bodily harm and food contamination.

[76] The investigation revealed that DEG had been used as a coolant for the brewery equipment, in what should have been a closed circuit, but an undetected leak in the system contaminated some batches of beer.

The regional drug controller authorities after investigation found out that a faulty batch of the Coldbest PC cough syrup contained 34.97% of diethylene glycol, which resulted in poisoning and subsequent renal failures.

[77][78] The WHO issued a medical product alert for four "contaminated" Indian pediatric medicines, manufactured by a firm in Haryana's Sonepat, saying these drugs identified in Gambia had been potentially linked with acute kidney injuries and 70 deaths among children in the west African country.