Diethylene Glycol in Panama: 63 Rulings and the Quality Lesson

In Panama, the 2006 mass poisoning with diethylene glycol is still in court. According to La Prensa (October 18, 2026), the Third Chamber (Contentious-Administrative) of the Supreme Court of Justice has received 472 compensation claims and had issued 63 rulings against the State, most of them in 2026¹. This article reviews the numbers, the technical origin of the contamination and what the case teaches physicians and researchers about quality control, attributing to each source only what it says.

Diethylene glycol in Panama: the October 2026 numbers

Besides the money, the rulings order written public apologies to each affected person, a monument with a plaque at the Ciudad de la Salud listing the recognized victims, and a CSS web section with a map by province¹. The first ruling of this cycle, in April 2026, awarded US$25,000 to each of three victims who had sued for US$6 million².

Death counts differ between sources. La Prensa reports the official figure of 800 and about 1,300 people with lasting effects¹; the victims' committee speaks of 1,200 to 1,500 deaths overall and says it gathered evidence of more than 400 deaths between 2004 and 2006⁴. These are different estimates built on different methods and should be cited as such.

How fake glycerin reached a CSS syrup

La Prensa reports that the Chinese company Taixing Glycerin Factory shipped a compound with a high percentage of diethylene glycol labeled as glycerin, which reached Panama in 2004; the CSS bought it from a foreign supplier and used it at its Laboratorio de Producción de Medicamentos for syrups and creams¹. A four-country investigation identified that factory, and its certificate of analysis said the shipment was 99.5 % pure¹⁰.

The CDC case-control study in the Bulletin of the World Health Organization found a very strong association between the prescription syrup and the illness (adjusted odds ratio 31.0; 95 % CI 6.93–138), with diethylene glycol in 8 % of syrup samples and 22 % of the glycerin used to make it; the investigation led to the recall of about 60,000 bottles⁶. A CDC systematic review attributes these poisonings to two recurring causes: deception about the true nature of an ingredient somewhere in the chain, and failure to follow quality-control procedures in manufacturing⁹.

In 2025 a joint WHO–UNODC report documented at least 25 excipient-contamination incidents with more than 1,300 deaths over 90 years, and called for legal frameworks against the deliberate falsification of labels, certificates of analysis and composition¹². La Prensa summarizes that report as describing conduct such as altering certificates, relabeling drums and no impurity testing at the end of the chain⁵.

What the clinic showed: kidney and nerve

In a review of 46 patients at the CSS Metropolitan Hospital, 87 % had neurologic signs, including limb or facial weakness, and 27 (59 %) died despite intensive care and hemodialysis⁷. The authors recommend considering diethylene glycol in facial or limb weakness with unexplained acute kidney injury. In an 18-month follow-up of 32 enrolled survivors (5 died and 26 completed follow-up), neurologic findings tended to improve and there was no evidence of delayed-onset renal or neurologic disease⁸.

Quality control: identity, purity and lot traceability

The FDA's May 2023 guidance on glycerin and other high-risk components cites the October 2006 outbreak in Panama in its background and notes that manufacturers relied on the supplier's certificate of analysis¹⁴¹³. It recommends testing samples from all containers of all lots and sets a limit of not more than 0.10 % diethylene glycol and ethylene glycol¹⁴. In January 2023 WHO asked manufacturers to buy excipients only from qualified suppliers, test them on receipt and before use, and keep complete purchase, testing, manufacturing and distribution records so a lot can be traced¹¹.

The practical lesson for anyone working with injectable or research products is that a certificate is a document, not proof. Identity (which molecule it is), purity (how much of it, and what else) and traceability (which lot it came from and who handled it) are verified separately and per lot. We explained the method in how to verify a COA and a lot in Panama, in the certificate of analysis article and in how to read the label and the COA. Research products on this site are for research use only and are not for human or veterinary use.

Pharmacovigilance: what is monitored in Panama today

Gabriel Pascual, spokesman for the victims' committee, argues that what happened «can happen again in Panama»: he says there are no production laboratories or controls that guarantee traceability of medicines and supplies, that the systems «did not improve», and that neither the Minsa nor the CSS has a victim follow-up protocol⁴. That is one party's view. As verifiable context, CSS director Dino Mon said in April 2026 that expired medicines and supplies worth US$2.5 million were found in the Felipillo and El Crisol depots and that the total could be larger³.

The National Directorate of Pharmacy and Drugs (DNFD) of the Ministry of Health (Minsa) does relay international alerts: it reported that the syrups in the WHO alerts for the Gambia and for Uzbekistan do not appear in its registry¹⁵¹⁶. In 2019 it seized toothpaste containing diethylene glycol on Avenida Central¹⁷. On the adverse-reaction reporting system, see our guide to pharmacovigilance in Panama.