Sosa had watched as other doctors identified the cause of another epidemic, later identified as hantavirus, a pathogen spread by infected rodents. The next time, he vowed, would be different. As a precaution, the patients with the mystery illness were segregated and placed in a large empty room awaiting renovation. Health care workers wore masks, heightening fears in the hospital and the community. Jorge Motta, a cardiologist who runs the Gorgas Memorial Institute, a widely respected medical research center in Panama. Meanwhile, patients kept coming, and hospital personnel could barely keep up.
Recognition and Management of Acute Medication Poisoning
Frightened hospital patients had to watch others around them die for reasons no one understood, fearing that they might be next. In late September she was treated and sent home. Within days, she could no longer eat; she stopped urinating and went into convulsions. A decision was made to take her to the public hospital in Panama City, but on the way she stopped breathing and had to be resuscitated.
She arrived at the hospital in a deep coma and later died. Medical records contained clues but also plenty of false leads. Early victims tended to be males older than 60 and diabetic with high blood pressure.
The Power of Poison: Poison as Medicine
About half had been given Lisinopril, a blood pressure medicine distributed by the public health system. But many who did not receive Lisinopril still got sick. On the chance that those patients might have forgotten that they had taken the drug, doctors pulled Lisinopril from pharmacy shelves — only to return it after tests found nothing wrong. Investigators would later discover that Lisinopril did play an important, if indirect role in the epidemic, but not in the way they had imagined.
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A Major Clue. One patient of particular interest to Dr. While undergoing treatment, the patient received several drugs, including Lisinopril. After a while, he began to exhibit the same neurological distress that was the hallmark of the mystery illness. Sosa recalled saying. This patient developed the disease in the hospital, in front of us. Soon after, another patient told Dr.
Sosa that he, too, developed symptoms after taking Lisinopril, but because the medicine made him cough, he also took cough syrup — the same syrup, it turned out, that had been given to the heart patient. View all New York Times newsletters. Sosa recalled. The cough medicine had not initially aroused much suspicion because many victims did not remember taking it. Motta said. Investigators from the United States Centers for Disease Control and Prevention, who were in Panama helping out, quickly put the bottles on a government jet and flew them to the United States for testing.
The next day, Oct. The tests, the C. The mystery had been solved. The barrels labeled glycerin turned out to contain poison. A nationwide campaign was quickly begun to stop people from using the cough syrup. Neighborhoods were searched, but thousands of bottles either had been discarded or could not be found. As the search wound down, two major tasks remained: count the dead and assign blame.
Neither has been easy. A precise accounting is all but impossible because, medical authorities say, victims were buried before the cause was known, and poor patients might not have seen doctors. Another problem is that finding traces of diethylene glycol in decomposing bodies is difficult at best, medical experts say. Nonetheless, an Argentine pathologist who has studied diethylene glycol poisonings helped develop a test for the poison in exhumed bodies. Seven of the first nine bodies tested showed traces of the poison, Panamanian authorities said.
With the rainy season returning, though, the exhumations are about to end.
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Local prosecutors have made some arrests and are investigating others connected to the case, including officials of the import company and the government agency that mixed and distributed the cold medicine. But prosecutors have yet to charge anyone with actually making the counterfeit glycerin. And if the Panama investigation unfolds as other inquiries have, it is highly unlikely that they ever will.
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A Suspect Factory. Panamanians wanting to see where their toxic nightmare began could look up the Web site of the company in Hengxiang, China, that investigators in four countries have identified as having made the syrup — the Taixing Glycerine Factory. There are no tall buildings in Hengxiang, a country town with one main road.
The factory is not certified to sell any medical ingredients, Chinese officials say. And it looks nothing like the picture on the Internet. In reality, its chemicals are mixed in a plain, one-story brick building. The factory is in a walled compound, surrounded by small shops and farms. In the spring, nearby fields of rape paint the countryside yellow. The Taixing Glycerine Factory bought its diethylene glycol from the same manufacturer as Mr. Wang, the former tailor, the government investigator said. Traders should be thoroughly familiar with their suppliers, United States health officials say.
Murray Lumpkin, deputy commissioner for international and special programs for the Food and Drug Administration.
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In the Panama case, names of suppliers were removed from shipping documents as they passed from one entity to the next, according to records and investigators. That is a practice some traders use to prevent customers from bypassing them on future purchases, but it also hides the provenance of the product.
The first distributor was the Beijing trading company, CNSC Fortune Way, a unit of a state-owned business that began by supplying goods and services to Chinese personnel and business officials overseas. Whether the Taixing Glycerine Factory actually performed the test has not been publicly disclosed. Original certificates of analysis should be passed on to each new buyer, said Kevin J.
In this case, that was not done. Upon receiving the barrels in September , the Spanish company, Rasfer International, did not test the contents, either. It copied the chemical analysis provided by Fortune Way, then put its logo on it. Criado said. In Panama, the barrels sat unused for more than two years, and officials said Medicom improperly changed the expiration date on the syrup. During that time, the company never tested the product. And the Panamanian government, which bought the 46 barrels and used them to make cold medicine, also failed to detect the poison, officials said. The toxic pipeline ultimately emptied into the bloodstream of people like Ernesto Osorio, a former high school teacher in Panama City.
He spent two months in the hospital after ingesting poison cough syrup last September. Just before Christmas, after a kidney dialysis treatment, Mr. Osorio said, his partly paralyzed face hanging like a slab of meat.
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