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Jamshidi N, Dhaliwal N, Hearn D, McCalman C, Wenzel R, Koutsogiannis Z, Roberts DM. Life-threatening barium carbonate poisoning managed with intravenous potassium, continuous veno-venous haemodialysis and endoscopic removal of retained ceramic glazes. Clin Toxicol (Phila) 2022; 60:974-978. [PMID: 35506754 DOI: 10.1080/15563650.2022.2068424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Barium poisoning is rare but potentially severe. We describe a case of acute barium carbonate poisoning with cardiac arrest, managed with intravenous potassium, dialysis and endoscopic removal of retained ceramic glazes. CASE REPORT A 38-year-old woman presented with vomiting 90 min after ingesting 3 cups of barium and strontium carbonate. Initial bloods noted potassium 2.8 mmol/L and creatinine 53 μmol/L. Electrocardiogram demonstrated prolonged corrected QT interval 585msec. Initial management included intravenous potassium. Four hours post-ingestion she developed proximal muscle weakness in upper limbs with a potassium of 2.2 mmol/L. At 15 h post-ingestion she developed profound muscle weakness, polymorphic ventricular tachycardia and cardiac arrest. Treatment included defibrillation, endotracheal intubation and continuous veno-venous haemodialysis (CVVHD) for metabolic derangement and enhanced elimination of barium. Chest X-ray 17 h post-ingestion demonstrated a large radio-opaque mass in the stomach, thought to be the ceramic glaze. Endoscopy removed the retained material 41 h post-ingestion. She was extubated 58 h post-ingestion and CVVHD was ceased on day 3. Serum creatinine peaked at 348 μmol/L on day 7, but normalised by discharge. Biphasic barium concentrations were noted, notably 94 μmol/L on admission, 195 μmol/L at 16 h, 95 μmol/L at 20 h, and 193 μmol/L at 30 h post-ingestion. CONCLUSION In barium poisoning with hypokalaemia, prompt potassium supplementation is required but rebound hyperkalaemia can occur. Endoscopic removal of ceramic glazes may be useful more than 12 h post-ingestion. Consider extracorporeal methods to enhance barium elimination in severe cases.
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Affiliation(s)
- Nazila Jamshidi
- New South Wales Poisons Information Centre, The Children's Hospital Westmead, Westmead, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Nina Dhaliwal
- New South Wales Poisons Information Centre, The Children's Hospital Westmead, Westmead, Australia.,Department of Emergency Medicine, Nepean Hospital, Penrith, Australia
| | - Dean Hearn
- Department of Intensive Care, Lismore Base Hospital, Lismore, Australia
| | - Craig McCalman
- Department of Intensive Care, Lismore Base Hospital, Lismore, Australia
| | - Ross Wenzel
- NSW Health Pathology, Trace Elements Laboratory, Royal North Shore Hospital, St Leonards, Australia
| | - Zeff Koutsogiannis
- New South Wales Poisons Information Centre, The Children's Hospital Westmead, Westmead, Australia.,Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Australia
| | - Darren M Roberts
- New South Wales Poisons Information Centre, The Children's Hospital Westmead, Westmead, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia
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Fenu EM, Brower JO, O'Neill TE. Suicide by an Unusual Compound: A Case of Barium Acetate Toxicity. Am J Forensic Med Pathol 2021; 42:286-288. [PMID: 33491946 DOI: 10.1097/paf.0000000000000663] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Forensic pathologists may sometimes encounter cases of suicide with ingestion of unusual compounds. Herein, we describe a case of suicide by ingestion of barium acetate. Deaths by ingestion of this compound have not previously been reported in literature. This case shows the clinical presentation of the toxicity of barium compounds and highlights the importance of scene investigation and clinicopathologic correlation in suicides by unusual ingestion.
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Affiliation(s)
- Elena M Fenu
- From the Wake Forest Baptist Health, Winston Salem
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McNeill IR, Isoardi KZ. Barium poisoning: an uncommon cause of severe hypokalemia. TOXICOLOGY COMMUNICATIONS 2019. [DOI: 10.1080/24734306.2019.1691340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Iain R. McNeill
- Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Katherine Z. Isoardi
- Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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Stanley MK, Kelers K, Boller E, Boller M. Acute barium poisoning in a dog after ingestion of handheld fireworks (party sparklers). J Vet Emerg Crit Care (San Antonio) 2019; 29:201-207. [DOI: 10.1111/vec.12820] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 04/24/2017] [Accepted: 06/12/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Monique K. Stanley
- U‐Vet Animal HospitalFaculty of Veterinary and Agricultural SciencesUniversity of Melbourne Werribee Australia
| | - Kylie Kelers
- U‐Vet Animal HospitalFaculty of Veterinary and Agricultural SciencesUniversity of Melbourne Werribee Australia
| | - Elise Boller
- U‐Vet Animal HospitalFaculty of Veterinary and Agricultural SciencesUniversity of Melbourne Werribee Australia
| | - Manuel Boller
- U‐Vet Animal HospitalFaculty of Veterinary and Agricultural SciencesUniversity of Melbourne Werribee Australia
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Bhoelan BS, Stevering CH, van der Boog ATJ, van der Heyden MAG. Barium toxicity and the role of the potassium inward rectifier current. Clin Toxicol (Phila) 2014; 52:584-93. [DOI: 10.3109/15563650.2014.923903] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lech T. Application of ICP-OES to the determination of barium in blood and urine in clinical and forensic analysis. J Anal Toxicol 2013; 37:222-6. [PMID: 23471954 DOI: 10.1093/jat/bkt015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Exposure to barium (Ba) mostly occurs in the workplace or from drinking water, but it may sometimes be due to accidental or intentional intoxication. This paper presents a reliable, sensitive method for the determination of Ba in blood and urine: inductively coupled plasma optical emission spectrometry (ICP-OES) after microwave digestion of samples. The overall procedure was checked using Seronorm Whole Blood L-2, Trace Elements Urine and spiked blood and urine samples (0.5-10 µg/mL of Ba). The accuracy of the whole procedure (relative error) was 4% (blood) and 7% (urine); the recovery was 76-104% (blood) and 85-101% (urine). The limits of detection and quantification (Ba λ = 455.403 nm) were 0.11 and 0.4 µg/L of Ba, respectively; precision (relative standard deviation) was below 6% at the level of 15 µg/L of Ba for blood. This method was applied to a case of the poisoning of a man who had been exposed at the workplace for over two years to powdered BaCO3, and who suffered from paralysis and heart disorders. The concentrations of Ba, in μg/L, were 160 (blood), 460 (serum) and 1,458 (urine) upon his admission to the hospital, and 6.1 (blood) and 4.9 (urine) after 11 months (reference values: 3.34 ± 2.20 µg/L of Ba for blood and 4.43 ± 4.60 µg/L of Ba for urine).
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Affiliation(s)
- Teresa Lech
- Institute of Forensic Research, Krakow, Poland.
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