Physiology: barium decreases potassium efflux from muscle cells by blocking potassium channels (with no activity on the sodium-potassium ATP-dependent pump) -> extracellular hypokalemia and intracellular hyperkalemia
Muscle accounts for approxmately 44% of body mass -> serum potassium level decreases (sometimes precipitously) resulting in paralysis
Gastric Lavage with Sodium Sulfate: may be indicated for barium ingestion
Sulfate precipitates with barium, forming non-toxic barium sulfate
Charcoal: ineffective for barium ingestion
Hemodialysis (see Hemodialysis, [[Hemodialysis]]): effective at removing barium, but generally not necessary
Aggressive Potassium Replacement: preferred treatment (even though total body potassium levels are likely not decreased in the setting of barium intoxication)
Serum potassium level must increase enough to displace barium from the potassium channels -> with replacement, symptoms decrease by 24 hrs later
Treatment of Arrhythmias: treat with potassium replacement, rather than antiarrhythmics
Treatment of Hypertension: nitroglycerin is preferred
References
Severe barium sulphate aspiration: a report of two cases and review of the literature. SIGNA VITAE 2007; 2(1): 25-28
Acute barium poisoning with respiratory failure and rhabdomyolysis. Ann Emerg Med. 1991 Oct;20(10):1138-42
Cardiac arrhythmias, respiratory failure, and profound hypokalemia in a trauma patient. Cleveland Clinic J Med; Vol 68(5) MAY 2001
