Barium oxide, obtained by calcining witherite

Direct observations: clinical cases, poisoning incidents and other

Administrative data

Endpoint:

direct observations: clinical cases, poisoning incidents and other

Type of information:

other: case study

Adequacy of study:

weight of evidence

Reliability:

4 (not assignable)

Rationale for reliability incl. deficiencies:

other: patient presented after purposeful ingestion of barium chloride with suicidal attempt, but due to single case occurence data can only be assessed as weight of evidence.

Data source

Reference

Reference Type:

publication

Title:

Acute Renal Failure Associated with Barium Chloride Poisoning

Author:

Wetherill, SF et al.

Year:

1981

Bibliographic source:

Annals of Internal Medicine

Materials and methods

Study type:

poisoning incident

Endpoint addressed:

acute toxicity: oral

Test guideline

Qualifier:

no guideline available

Principles of method if other than guideline:

Patient presented with signs of acute barium intoxication after wilfull ingestion of barium chloride with suicidal intent.

GLP compliance:

not specified

Test material

Test material information

Constituent 1

Reference substance name:

Barium chloride

EC Number:

233-788-1

EC Name:

Barium chloride

Cas Number:

10361-37-2

IUPAC Name:

barium dichloride

Details on test material:

The exact formulation of the barium chloride ingested by the patient was not provided.

Method

Type of population:

occupational

Subjects:

- Number of subjects exposed: 1
- Sex: male
- Age: 52
- Race: no data
- Known diseases: alcoholic, depressed with suicidal intentions

Ethical approval:

not applicable

Route of exposure:

oral

Reason of exposure:

intentional

Exposure assessment:

estimated

Details on exposure:

patient had ingested 1 teaspoonful of barium chloride, which was estimated to constitute about 13 mg, 8 hours prior to seeking medical attention

Examinations:

- Urine analysis: urinary parameters, volume
- Haematology: full blood and electrolytes

Medical treatment:

In the 8 hours after hospitalization, patient was infused with 14 g of magnesium sulfate. In parallel, hypokalemia was treated with 240 meq potassium, given over 16 hours. Renal failure and high blood urea nitrogen as well as creatinine prompted the onset of peritoneal dialysis.

Results and discussion

Clinical signs:

patient was admitted with intractable diarrhea, singultus, abdominal pain, and mild weakness of the lower extremities with diminished reflexes.

Results of examinations:

- Urine analysis: normal at time of admission, urinary parameters dropped after administration of magnesium sulfate with occurence of urinary sediment consisting of renal tubular cells and granular casts, urinary volumes ranged from 500 ml after admission to 5000 ml on hospital day 11.
- Haematology: unremarkable upon admission, then rapid onset of hypokalemia, which increased after potassium infusion. Due to renal failure, blood urea nitrogen and creatinine drastically increased transiently.
- Lung function parameters: Lung function was impaired by progressing paralysis, finally leading to the need for mechanical ventilation
- Neurological: slight weekness in lower limbs upon hospitalization, then rapidly progressing paralysis which ascended and also affected the respiratory musculature.

Effectivity of medical treatment:

infusion of potassium and magnesium sulfate led to a recovery of blood hypokalemia, however the parenteral administration of sulfate probably prompted the formation of insoluble barium crystals in the kidney, leading to nepthropathy.

Outcome of incidence:

patient recovered fully and was asymptomatic three months after discharge.

Applicant's summary and conclusion

Executive summary:

The patient had purposefully ingested 8 mg barium chloride, which led to severe abdominal cramps with diarrhea, muscle weakness cumulating in paralysis and renal failure. During renal failure, blood pressure was increased. In conclusion, ingestion of 8 mg barium chloride results in life-threatening and potentially lethal symptoms.