Life-threatening barium carbonate poisoning managed with intravenous potassium, continuous veno-venous haemodialysis and endoscopic removal of retained ceramic glazes

Clin Toxicol (Phila). 2022 Aug;60(8):974-978. doi: 10.1080/15563650.2022.2068424. Epub 2022 May 4.


Introduction: Barium poisoning is rare but potentially severe. We describe a case of acute barium carbonate poisoning with cardiac arrest, managed with intravenous potassium, dialysis and endoscopic removal of retained ceramic glazes.

Case report: A 38-year-old woman presented with vomiting 90 min after ingesting 3 cups of barium and strontium carbonate. Initial bloods noted potassium 2.8 mmol/L and creatinine 53 μmol/L. Electrocardiogram demonstrated prolonged corrected QT interval 585msec. Initial management included intravenous potassium. Four hours post-ingestion she developed proximal muscle weakness in upper limbs with a potassium of 2.2 mmol/L. At 15 h post-ingestion she developed profound muscle weakness, polymorphic ventricular tachycardia and cardiac arrest. Treatment included defibrillation, endotracheal intubation and continuous veno-venous haemodialysis (CVVHD) for metabolic derangement and enhanced elimination of barium. Chest X-ray 17 h post-ingestion demonstrated a large radio-opaque mass in the stomach, thought to be the ceramic glaze. Endoscopy removed the retained material 41 h post-ingestion. She was extubated 58 h post-ingestion and CVVHD was ceased on day 3. Serum creatinine peaked at 348 μmol/L on day 7, but normalised by discharge. Biphasic barium concentrations were noted, notably 94 μmol/L on admission, 195 μmol/L at 16 h, 95 μmol/L at 20 h, and 193 μmol/L at 30 h post-ingestion.

Conclusion: In barium poisoning with hypokalaemia, prompt potassium supplementation is required but rebound hyperkalaemia can occur. Endoscopic removal of ceramic glazes may be useful more than 12 h post-ingestion. Consider extracorporeal methods to enhance barium elimination in severe cases.

Keywords: Barium; endoscopy; hypokalaemia; strontium; toxicity; ventricular tachycardia.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Barium
  • Carbonates
  • Ceramics
  • Continuous Renal Replacement Therapy*
  • Creatinine
  • Endoscopy
  • Female
  • Heart Arrest* / chemically induced
  • Heart Arrest* / therapy
  • Humans
  • Muscle Weakness
  • Poisoning* / therapy
  • Potassium


  • Carbonates
  • Barium
  • barium carbonate
  • Creatinine
  • Potassium