who survive but develop kidney failure remain dialysis-dependent. All patients are likely to suffer significant morbidity. Epidemiology The physical properties of diethylene glycol make it an excellent counterfeit for pharmaceutical-grade glycerine (also called glycerol) or propylene glycol, and has caused many deaths in different countries. Incidents include its use in China as a component of cheap toothpaste, and by winemakers in Europe as an adulterant to create a "sweet" wine. 1937 – The Massengill incident (United States) In 1937, S. E. Massengill Co. (a Tennessee drug company), manufactured sulfanilamide dissolved with diethylene glycol, to create a liquid alternative of this drug. The company tested the new product, Elixir sulfanilamide, for viscosity, appearance and fragrance. At the time, the food and drug laws did not require toxicological analysis before releasing for sale. 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. This episode was the impetus for the Federal Food, Drug, and Cosmetic Act of 1938. This law, though extensively amended in subsequent years, remains the central foundation of FDA regulatory authority to the present day. 1969 – South Africa In Cape Town, South Africa, seven children developed vomiting, diarrhea, and dehydration, and died of kidney failure after administration of over-the-counter sedatives. Soon, patients started to present anuria, acidic breathing, hepatomegaly, and unresponsiveness. Patients were treated with fluid hydration and correction of acidosis, but some were not able to survive. Postmortem examination revealed damage in the kidneys and liver, and laboratory testing found DEG instead of propylene glycol in the sedatives. 1985 – Spain Patients being treated for burns developed sudden anuric kidney failure. Further investigation revealed all patients were treated with topical silver sulfadiazine ointment that contained 7 g/kg of DEG. This event caused the death of five patients. 1985 – Wine scandal (Austria) During the month of July 1985, Austrian wines were found to contain up to 1,000 parts per million of DEG, giving them a desirable sweetness. Austrian wine was banned in many countries and the U.S. Bureau of Alcohol, Tobacco and Firearms started to test all imported wine. 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. 45 Austrian, 5 German and 12 Italian wines tested positive for DEG.