From profound hypokalemia to life-threatening hyperkalemia: a case of barium sulfide poisoning.

We describe a 25-year-old man who was brought to the emergency department with skeletal muscle weakness, respiratory arrest, and rhabdomyolysis, as well as life-threatening hyperkalemia, after ingesting a depilatory containing barium sulfide (Magic Shave; Carson Products Co, Savannah, Ga). The findings of his physical examination were significant for hyporeflexia with marked weakness. He was in respiratory distress and required intubation and ventilatory support owing to progressive weakness of the respiratory muscles. His serum potassium level was 1.5 mmol/L. He was treated with intravenous and oral potassium. His serum potassium level peaked at 8.3 mmol/L and his serum creatine kinase level at 8286 IU/L. His acute respiratory weakness resolved with correction of the potassium concentration; his rhabdomyolysis responded well to hydration; and his renal function returned to normal. We also discuss the various pathophysiological findings in this case and compare our patient with another who, despite ingesting a similar amount of the same hair remover, did not develop any of the above complications.