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Diabetic ketoacidosis in adolescents can be a cause of severe morbidity and mortality, especially if unrecognized at the time of first diagnosis (1). We present a 15-year-old girl who was initially treated for “diabetic ketoacidosis” with further worsening of her general condition. This delayed recovery, coupled with focused investigations, finally led us to a diagnosis and the appropriate management of an intentional overdose with organophosphorous (OP) pesticide, presenting as diabetic ketoacidosis. Our aim is also to raise awareness of the effects of organophosphates, widely used as pesticides, on glucose metabolism, and its potential implications in the epidemic of diabetes worldwide. A 15-year-old girl was admitted with a 10-h history of giddiness, vomiting, and drowsiness. She was apparently well the evening prior to her admission. Clinical examination …

[The Indian] parliament has passed the Infant Milk Substitutes Feeding Bottles and Infant Foods (Regulation of Production Supply and Distribution) Bill which when it comes into force will severely restrict the advertising and promotion of these baby products. Essentially the bill incorporates the contents of the International Baby Food code adopted by the World Health Assembly in 1981 but expands its scope to include infant foods--i.e. foods being marketed "as a complement to mothers milk to meet the growing nutritional needs of the infant after the age of 4 months". Apart from disallowing the advertising of these products the bill prohibits the distribution of free samples and the offer of other inducements for promoting them. Donations of infant-milk substitutes and bottles may be made only to orphanages. The law also lays down stringent conditions for the labeling of baby foods and categorically bans the use of pictures of an infant or a woman or both or the use of words such as "humanized" or "maternalized" in the information printed on the containers. All information material on the product must promote breastfeeding and stress the "financial and social implications" of using infant formulas and baby bottles. Further manufacturers are forbidden from offering inducements to or fixing salaries of employees on the basis of volume of sales. Offenses under this act may be punishable by imprisonment for up to 3 years or a fine of up to Rs 500. Not surprisingly baby-food manufacturers opposed the bill tooth and nail and succeeded in stalling it for a considerable time. There is after all a huge and growing market at stake. According to a Voluntary Health Association of India estimate the market for baby foods worth nearly Rs 7200 million (approximately 180 million pounds)--almost entirely shared between Amul the manufacturing unit of a highly successful and pathbreaking Indian milk cooperative venture and Nestle--is growing at 6%/year. The bill has had a long and interrupted passage. A diluted version was 1st introduced in Parliament in 1986 when it was passed by the Upper House but lapsed with the dissolution of the Lower House. The current version of the bill was introduced in January; again it lapsed with the dissolution of the House and was reintroduced in May. Institutions such as the Indian Academy of Pediatrics the Consumer Guidance Society of India and the Voluntary Health Association of India have endorsed the bill and have played a leading role in having it enacted in parliament. The question now is whether the law can be implemented successfully. The problems are many. For one the law makes food inspectors appointed under the food Adulteration Act responsible for taking cognizance of any offenses under it. The already overworked and often corrupt inspection staff is hardly likely to take the new task seriously. Secondly the bill makes illegal the use of the health system or its employees for the promotion or advertising of these baby products which implies the existence of an agency that will monitor or at least keep watch over the functioning of the health system. There is no such agency and the proliferating private sector in health care is largely unregulated. And thirdly there is the other side of the coin--restricting the promotion of baby food must be accompanied by creation of conditions that enable the vast majority of poor women to breastfeed. Such a task in a country where most women are forced to work in the unorganized sector would be colossal. (full text)