Acute barium poisoning with respiratory failure and rhabdomyolysis

Johnson, Charles H.; VanTassell, V Jefferson

doi:10.1016/s0196-0644(05)81393-9

“…Barium poisoning may cause hypokalemia, high blood pressure, renal failure, and death by cardiac arrest (Patton 1994, Downs 1995, Fogliani et al 1993, Johnson and Vantassell 1991, Agarwal et al 1995, Gupta 1994, Sandmeyer and Probst 1988.…”

Section: 56mentioning

confidence: 99%

Barium

Jaritz¹

2004

Elements and Their Compounds in the Environment

3

1

0

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“…Acute toxic effects of Ba 2ϩ , which include hypertension, are consistent with block of K IR . 14 Human studies identified a no-observed adverse-effect dose of 0.21 mg barium/kg body wt per day. 15,16 These data were used by the US Environmental Protection Agency to calculate a chronic oral reference dose of 0.07 mg/kg per day.…”

mentioning

confidence: 99%

Barium Reduces Resting Blood Flow and Inhibits Potassium-Induced Vasodilation in the Human Forearm

Dawes

¹

,

Sieniawska

²

,

Delves

³

et al. 2002

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Background — Increasing extracellular K + concentration within and just above the physiological range hyperpolarizes and relaxes vascular smooth muscle in vitro. These actions involve inwardly rectifying potassium channels (K IR ) and Na + /K + ATPase, which are inhibited, respectively, by Ba 2+ and ouabain. The role (if any) of K IR in controlling human resistance vessel tone is unknown, and we investigated this in the forearm. Methods and Results — Blood flow was measured by plethysmography in healthy men. Drugs and electrolytes were infused through the brachial artery. BaCl 2 (4 μmol/min, also used in subsequent experiments) increased Ba 2+ plasma concentration in the infused forearm to 50±0.8 μmol/L (mean±SEM) and reduced blood flow by 24±4% (n=8, P <0.001) without causing systemic effects. Ouabain (2.7 nmol/min), alone and with BaCl 2 , reduced flow by 10±2% and 28±3%, respectively (n=10). Incremental infusions of KCl (0.05, 0.1, and 0.2 mmol/min) increased flow from baseline by 1.0±0.2, 2.0±0.4, and 4.2±0.5 mL/min per deciliter forearm, respectively. Responses to KCl (0.2 mmol/min) were inhibited by BaCl 2 , alone and plus ouabain, by 60±9% and 88±6%, respectively (both P ≤0.01). In control experiments, norepinephrine (240 pmol/min) reduced blood flow by 24±2% but had no significant effect on K + -induced vasodilation. BaCl 2 , alone or with ouabain, did not significantly influence responses to verapamil or nitroprusside. Conclusions — Ba 2+ increases forearm vascular resistance. K + -induced vasodilation is selectively inhibited by Ba 2+ and almost abolished by Ba 2+ plus ouabain, suggesting a role for K IR and Na + /K + ATPase in controlling basal tone and in K + -induced vasorelaxation in human forearm resistance vessels.

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“…Major hypokalemia is seen in severe cases. Further abnormalities may include hypophosphatemia and rhabdomyolysis (2). Barium is a competitive potassium channel antagonist, blocking the passive efflux of intracellular potassium (3).…”

Section: Discussionmentioning

confidence: 99%

“…Intravenous administration of sodium sulphate is no longer recommended since barium may precipitate in the kidneys, thus causing acute renal failure and possibly life-threatening hyperkalemia (11,12). Administration of activated charcoal is of no use, since it does not adsorb barium ions (2,5,6). Large amounts of intravenous potassium may be necessary to correct the hypokalemia.…”

Section: Discussionmentioning

confidence: 99%

Acute Barium Intoxication and Hemodiafiltration

Koch¹,

Appoloni

²

,

Haufroid

³

et al. 2003

Journal of Toxicology: Clinical Toxicology

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We report a case of severe hypokalemia and flaccid muscle paralysis following a suicide attempt associating the calcium channel blocker amlodipine, the antidepressant fluoxetine and barium carbonate. Despite rapid correction of severe, life-threatening hypokalemia, areflexic quadriplegia persisted, suggesting a direct effect of barium on muscle cells. Continuous veno-venous hemodiafiltration (CVVHDF) was initiated. We determined barium concentration in the urine, plasma, and hemodiafiltrate during CVVHDF. We subsequently calculated the amounts of barium eliminated both by the CVVHDF and the kidneys. CVVHDF triples the measured barium elimination, reduced serum barium half-life by a factor of three, stabilized serum potassium levels, and rapidly improved motor strength, with complete neurological recovery within 24 h. Presentation and treatment of barium intoxication are discussed.

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Acute barium poisoning with respiratory failure and rhabdomyolysis

Cited by 72 publications

References 14 publications

Barium

Barium

Barium Reduces Resting Blood Flow and Inhibits Potassium-Induced Vasodilation in the Human Forearm

Acute Barium Intoxication and Hemodiafiltration

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