Barium, Elemental

CAS RN:7440-39-3

Treatment Overview

0.4.2 ORAL EXPOSURE
  • A) MANAGEMENT OF MILD TO MODERATE TOXICITY
    • 1) Monitor serum potassium and correct as necessary. Administer intravenous fluids to maintain urine.
  • B) MANAGEMENT OF SEVERE TOXICITY
    • 1) Profound hypokalemia may develop rapidly, causing profound weakness, respiratory insufficiency, and dysrhythmias. Monitor for weakness and respiratory insufficiency, manage airway early. Monitor serial serum potassium and correct aggressively. Dysrhythmias are usually secondary to hypokalemia and generally respond to potassium administration. Administer intravenous fluids to maintain adequate urine output. Hemodialysis should be performed in patients with severe hypokalemia, severe weakness, or ventricular dysrhythmias that are not responding to potassium supplementation.
  • C) DECONTAMINATION
    • 1) Activated charcoal likely ineffective in adsorbing barium. Consider insertion of a nasogastric tube to aspirate gastric contents, or gastric lavage, in patients with recent ingestion who can protect their airway or who are intubated.
    • 2) Wash exposed skin with soap and water. Remove contaminated clothing.
  • D) AIRWAY MANAGEMENT
    • 1) Severe hypokalemia may result in respiratory muscle weakness and respiratory failure. Monitor adequacy of respirations, and manage airway early if necessary.
  • E) MAGNESIUM SULFATE
    • 1) Magnesium sulfate when given orally results in the formation of nonabsorbable barium sulfate within the gastrointestinal tract. Dose: 250 mg/kg for children and 30 g for adults. Sodium sulfate is an alternative. ADULT: 30 g in 250 ml water orally.
  • F) HYPOKALEMIA
    • 1) Profound hypokalemia can develop rapidly. Aggressive supplementation, both orally and intravenously, is the mainstay of therapy.
  • G) DYSRHYTHMIAS
    • 1) Dysrhythmias are usually secondary to hypokalemia. Aggressive intravenous and oral potassium supplementation is the mainstay of treatment. Antidysrhythmics such as lidocaine or amiodarone may be used, but efficacy may be limited in patients with persistent hypokalemia.
  • H) HEMODIALYSIS
    • 1) Hemodialysis is effective (corrects hypokalemia, and associated weakness and dysrhythmias, enhances barium elimination) in patients with severe poisoning. It should be considered early in patients with hypokalemia, severe weakness or dysrhythmias that are not responding to potassium supplementation.
  • I) PATIENT DISPOSITION
    • 1) OBSERVATION CRITERIA: All patients who have ingested a soluble barium salt should be sent to a healthcare facility for evaluation and treatment. Patients should be observed for 6 to 8 hours with ECG monitoring, serial serum potassium concentrations, and evaluation for weakness. Patients who are asymptomatic with normal serum potassium during 6 to 8 hours of observation may be discharged.
    • 2) ADMISSION CRITERIA: Patients with hypokalemia, weakness or dysrhythmias should be admitted to an intensive care setting for cardiac, respiratory and neurologic monitoring and aggressive potassium replacement.
    • 3) CONSULT CRITERIA: Consult a medical toxicologist and/or poison center for any patient with significant barium poisoning or in whom the diagnosis is unclear. Consult a nephrologist for emergent dialysis in any patients with severe poisoning.
  • J) PITFALLS
    • 1) Inadequate monitoring for weakness, respiratory insufficiency, hypokalemia, dysrhythmias.
    • 2) Since barium does not decrease total body potassium, but rather shifts it intracellularly; hyperkalemia may develop once barium toxicity has resolved.
  • K) TOXICOKINETICS
    • 1) Rapidly absorbed, primarily fecal elimination. Half life 18 hours (based on single case report).
  • L) DIFFERENTIAL DIAGNOSIS
    • 1) Toluene toxicity, renal tubular acidosis, hypokalemic periodic paralysis.
Find more information on this substance at: Hazardous Substances Data Bank , TOXNET , PubMed