Difference between revisions of "Barium toxicity"

(Disposition)
 
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*[[Lactic acidosis]]
 
*[[Lactic acidosis]]
 
*[[Hypophosphatemia]]
 
*[[Hypophosphatemia]]
*[[Rhabdomyolsis]]
+
*[[Rhabdomyolysis]]
 
*Intravasation is rare but is most often seen with barium enemas causing bowel perforation
 
*Intravasation is rare but is most often seen with barium enemas causing bowel perforation
 +
 
==Differential Diagnosis==
 
==Differential Diagnosis==
 
{{Heavy metals list}}
 
{{Heavy metals list}}
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==Management==
 
==Management==
 
*Decontamination
 
*Decontamination
**Activated charcoal ''not'' recommended
+
**[[Activated charcoal]] ''not'' recommended
**NG lavage ''un''likely to benefit
+
**[[Gastric lavage]] ''un''likely to benefit
 
**Oral sodium sulfate or [[magnesium sulfate]]
 
**Oral sodium sulfate or [[magnesium sulfate]]
 
***Prevents absorption by precipitating barium ions into insoluble barium sulfate
 
***Prevents absorption by precipitating barium ions into insoluble barium sulfate
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**Consider prophylactic antibiotics
 
**Consider prophylactic antibiotics
 
**IV extravasation outcomes improved with aspiration of barium sulfate
 
**IV extravasation outcomes improved with aspiration of barium sulfate
 +
 
==Disposition==
 
==Disposition==
 
*Symptomatic admit to ICU
 
*Symptomatic admit to ICU
 
*Asymptomatic after 6 hours of observation with a normal potassium can be discharged
 
*Asymptomatic after 6 hours of observation with a normal potassium can be discharged
 
*Consult Toxicology or [[poison control]]
 
*Consult Toxicology or [[poison control]]
 +
 +
==See Also==
 +
*[[Toxicology (main)]]
 +
 
==References==
 
==References==
 
<references/>
 
<references/>

Latest revision as of 21:41, 8 March 2021

Background

  • Uses
    • Pesticides
    • Depilatory
    • Radiographic contrast
  • Most toxicity is seen in pesticides, which contain barium carbonate
  • Barium sulfate is used in contrast
    • Insoluble
    • Rarely causes unintentional toxicity
    • When they occur typically seen with oral contrast and barium enemas

Toxicokinetics

  • Toxicity seen with as little as 200mg of barium salt
  • Lethal dose ranges from 1-30 g of barium salt
  • Absorption through the GI tract is 5-10%
  • Rapid rate of redistribution
  • Half life of 18-85 hours
  • Mostly eliminated via GI tract
    • 10-28% renal elimination
  • Barium induces hypokalemia by causing extracellular potassium to shift intracellularly

Clinical Features

Differential Diagnosis

Heavy metal toxicity

Evaluation

  • BMP, including magnesium and phosphate
  • Serum barium >0.2mg/L is abnormal
  • EKG
  • Cardiac monitor
  • CPK
  • pH
  • Lactate
  • Consider radiographs, such as CT chest and abdomen to identify location of barium contrast in event of Intravasation

Management

  • Decontamination
  • Supportive care
  • Hemodialysis or CVVHDF
    • Both show increase elimination of barium
    • CVVHDF showed to triple elimination with complete neurologic recovery in 24 hours in one case report [1]
  • Intravasation
    • Consider prophylactic antibiotics
    • IV extravasation outcomes improved with aspiration of barium sulfate

Disposition

  • Symptomatic admit to ICU
  • Asymptomatic after 6 hours of observation with a normal potassium can be discharged
  • Consult Toxicology or poison control

See Also

References

  1. Koch M, Appoloni O, Haufroid V, Vincent JL, Lheureux P. Acute barium intoxication and hemodiafiltration. J Toxicol Clin Toxicol. 2003;41:363-367.

Dawson, A. Barium. In: Goldfrank's Toxicologic Emergencies. 9th Ed. New York: McGraw-Hill; 2011: 1434-1436