Clinical features and management strategies of acute soluble barium poisoning: a review of case reports.

Soluble barium salts including barium carbonate, nitrate, acetate, and chloride are commonly used in the manufacture of ceramics, insecticides, and rodenticides. Soluble barium salts are highly toxic to humans if ingested. Acute soluble barium poisoning is an uncommon but life-threatening problem. The fatal dose of barium chloride for man has been reported to be only 0.8 to 0.9 gram. Currently, there have been no systematic studies on acute soluble barium poisoning. Based on the retrospective analysis of 55 global cases, toxicological characteristics, clinical features and management of acute soluble barium poisoning were summarized. Barium is a competitive blocker of potassium inward rectifier channels to inhibit K+ efflux, resulting in profound hypokalemia. Acute soluble barium poisoning can result in gastrointestinal effects including vomiting and diarrhea, followed by hemodynamic disturbances, cardiac arrhythmias, muscle weakness, and cardiac arrest. Respiratory failure induced by muscle paralysis is the major cause of death. Management strategies mainly include prevention of barium absorption, administration of soluble sulfates, potassium supplementation, antiarrhythmic medications, hemodialysis/CVVHDF, and cardiorespiratory support. Timely administration of decontamination and correction of hypokalemia are the two important points. This narrative review will offer crucial information for treating patients with acute soluble barium poisoning.