Why is barium toxic

We suspected barium poisoning in our index case and samples of blood and urine were sent for toxicological analysis. Blood barium levels were Barium compounds are highly toxic when ingested with the exception of barium sulphate which is not absorbed from gut and hence commonly used as radiographic contrast. Fireworks contain Barium chlorate and nitrate which gives the yellow green flame on igniting [1].

Barium interferes with potassium transport, causing intracellular sequestration of the ion and severe hypokalemia. Effects of barium include gastroenteritis, cardiac instability, wide complex arrhythmias, muscle weakness, hypertension and respiratory failure []. Renal toxicity with ingestion of large amounts of barium is also reported [5]. Barium carbonate poisoning from rodenticide ingestion has been reported to cause acute rhabdomyolysis and hypophosphatemia. It is important to ensure that the serum potassium level was increased to 3.

Blood chemistry testing should be performed every two hours to specifically monitor the serum potassium level. In addition, attention should be given to the changes in ECG and urine volume to prevent the high potassium levels. Due to the lack of specificity in the early clinical symptoms, toxic poisoning as presented in this case is easily misdiagnosed. Combining the large number of barium-related toxicities in the past with clinical manifestations such as muscle paralysis, cardiovascular injury, low potassium levels, and ECG changes, and without symptoms caused by other factors, barium chloride poisoning was finally diagnosed [ 10 ].

In this case, we found that the decrease of serum potassium levels increased the levels of myoglobin and troponin, indicating possible myocardial injury. Fatal outcomes due to barium-related poisoning are not uncommon. In the early s, a pattern of illness, termed Pa-Ping, which caused a few deaths in the Sichuan province in China, was observed and investigated. The cause of the disease was due to large-scale food poisoning from the very high proportion of barium chloride in table-salt that was mined in the area [ 3 ].

Jiucheng reported that people were poisoned and 5 died after consuming flour containing barium chloride. The blood potassium level of the 5 decedents was less than 2. In , two outbreaks of barium poisoning occurred in a large number of people in different villages in Israel [ 12 ].

According to the literature, in all cases the patients presented severe and rapid hypokalemia, which was significant and resulted in various clinical effects. In general, hypokalemia is caused by frequent vomiting, severe diarrhea, too much diuretic, periodic paralysis, and other factors including the loss of potassium, which leads to the ST-T-U changes of ECG and arrhythmia [ 13 ]. The ECG revealed frequent premature ventricular contractions, atrioventricular blocking, ventricular tachycardia, prolongation of PR interval, ST segment depression 0.

Taking into account the clinical features, when a patient shows one of the symptoms shown below, barium poisoning should be considered. It should be noted that those are just initial thoughts: the final diagnosis still needs to be determined: 1 Obvious poisoning symptoms: nausea, vomiting, stomach burning feeling, dizziness, weakness, abdominal pain, and diarrhea 2 Hypokalemia: the serum level of potassium is 1.

In conclusion, this case exemplifies the weaknesses of management of toxic substances and the lack of mental health education for young students. The patient presented in this case is only 19 years old and suffered from a depression, which is not conducive to his healthy development.

Therefore, we should strengthen the supervision of toxic substances and enhance safety awareness to avoid the leakage of toxic substances. In addition, we should carry out mental health education on a regular basis to ensure a healthy living environment. Medical professionals should also be aware of the possibility of such accidents and be aware in suspicious cases. No conflict of interest exists in the submission of this manuscript, and the manuscript is approved by all authors for publication.

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Journal overview. Academic Editor: Dante Amato. Received 28 Aug Ann Emerg Med ; Barium toxicity after exposure to contaminated contrast solution—Goias State, Brazil, MMWR ; Dawson A. Agency for Toxic Substances and Disease Registry. Toxicological Profile for Barium and Barium Compounds[online]. Barium and compounds[online]. NIOSH manual of analytical methods [online].

Sampling and analytical methods [online]. Complications occurred in a woman following a barium swallow investigation for severe dysphagia. A family was accidentally poisoned with barium from eating their evening meal. The mother had fried fish breaded with a flour-like substance that turned out to be rat poison containing barium carbonate.

All seven family members, aged 2 to 48 years, developed nausea, vomiting, diarrhea, and crampy abdominal pain within minutes of consuming the meal; the parents also developed ventricular tachycardia, flaccid paralysis of the extremities, shortness of breath mother , and respiratory failure father. Patients were treated symptomatically and all fully recovered Johnson and VanTassell The diets of 11 male subjects were controlled.

They were given 1. No clinically significant effects were observed in blood pressures, serum chemistry, urinalysis, or electrocardiograms. The highest average dose in this study was calculated to be No significant clinical signs of toxicity were observed.

Blood pressure was not measured. McCauley et al. No other effects were reported. Tardiff et al. A slight reduction in adrenal weights was seen in female rats with the ppm No clear dose effect or dose duration effect was seen with the adrenal weight decrease; therefore, the clinical significance is uncertain.

Although significantly higher mortality rates from all cardiovascular diseases were observed with the higher barium level in the 65 and over age group, there were no significant individual differences in blood pressures, strokes, or heart and renal diseases within the two groups. The average barium concentration for the mortality study was 7. The barium doses were about 0. No adverse clinical effects were observed; however, blood pressure was not measured.

The overall average life span of the group, however, was about the same as the control group EPA , Perry et al. Average doses were calculated to be 0, 0. A clinically significant increase in average blood pressure was observed in the highest dose group; a slight but statistically significant increase was seen in the 10 ppm 0. The controlled diet, which restricted the intake of trace metals, calcium, and potassium, may have contributed to the effect.

See Sect. The uncertainty factor accounts for protecting sensitive individuals and is reduced from the usual factor of 10 because the selected studies examined the population judged most at risk. Barium oxide dust is considered a dermal and nasal irritant Beliles The effect of barium dusts on welders was investigated under simulated working conditions over a one-week time period Zschiesche et al.

Barium fume concentrations were 4. No adverse health effects on the welders were attributable to barium exposure, but there was a slight decrease in plasma potassium levels at the end of the work shift.

After removal from the sources of exposure, baritosis is reversible in most cases. Baritosis results in a significantly higher incidence of hypertension, but no changes are usually seen in pulmonary function Stokinger , EPA b. The high dose animals developed increased arterial pressure; decreased body weight gain; decreased blood levels of hemoglobin, sugar, protein, cholinesterase and thrombocytes; increased blood levels of leukocytes, phosphorous and alkaline phosphatase; increased urine calcium; and perivascular and peribronchial sclerosis in the lungs.

EPA , Tarasenko et al. Increased fetal mortality was observed following the mating of males exposed to barium carbonate 5.

Decreased sperm motility was observed in males treated with The mating of females exposed to Ovarian follicle atresia was seen in female rats exposed to 3. No significant adverse effects were noted with the 1. The study is described in Sect. LD 50 values for barium chloride, nitrate, and acetate were determined in two strains of mice by intravenous injection Syed and Hosain The affected animals either died within one hour or survived the treatment.

The LD 50 values obtained were 8.