Case Definition: Barium
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Clinical description
Ingestion of certain forms of barium (e.g., barium carbonate or barium fluoride) in toxic amounts leads to gastrointestinal symptoms (e.g., vomiting, abdominal pain, and watery diarrhea). Within 1--4 hours of ingestion, profound hypokalemia develops in certain instances, and potassium levels <1.0 mmol/L are associated with generalized muscle weakness that might progress to paralysis of the limbs and respiratory muscles (1-5).
Barium sulfate is not absorbed when taken by mouth and is therefore commonly used as a contrast agent for radiographic procedures.
Laboratory criteria for diagnosis
- Biologic: A case in which an elevated spot urine barium level (>7 µg/L) exists (20), as determined by commercial laboratory tests.
- OR-
- Environmental: Elevation of barium compounds in environmental samples, as determined by NIOSH or FDA.
Case classification
- Suspected: A case in which a potentially exposed person is being evaluated by health-care workers or public health officials for poisoning by a particular chemical agent, but no specific credible threat exists.
- Probable: A clinically compatible case in which a high index of suspicion (credible threat or patient history regarding location and time) exists for barium exposure, or an epidemiologic link exists between this case and a laboratory-confirmed case.
- Confirmed: A clinically compatible case in which laboratory tests have confirmed exposure.
The case can be confirmed if laboratory testing was not performed because either a predominant amount of clinical and nonspecific laboratory evidence of a particular chemical was present or a 100% certainty of the etiology of the agent is known.
Additional resources
- Sigue G, Gamble L, Pelitere M, et al. From profound hypokalemia to life-threatening hyperkalemia: a case of barium sulfide poisoning. Arch Intern Med 2000;160:548-51.
- Shankle R, Keane JR. Acute paralysis from inhaled barium carbonate. Arch Neurol 1988;45:579-80.
- Choudhury H, Cary R. Concise international chemical assessment document: barium and barium compounds. Geneva, Switzerland: World Health Organization; 2001.
- Johnson CH, VanTassell VJ. Acute barium poisoning with respiratory failure and rhabdomyolysis. Ann Emerg Med 1991;20:1138-42.
- CDC. Barium toxicity after exposure to contaminated contrast solution---Goias State, Brazil, 2003. MMWR 2003;52:1047-8.
This document is based on CDC’s best current information. It may be updated as new information becomes available.
Page last reviewed February 22, 2006
Page last modified March 16, 2005