Acute barium poisoning with respiratory failure and rhabdomyolysis

Barium is a divalent alkaline earth metal used as the insoluble sulfate salt in contrast radiography and soluble acid salts in industry. Barium poisoning results from ingestion or inhalation of the acid salts; the most common poisoning occurs after ingestion of the rodenticide barium carbonate (BaCO3). We report seven cases of BaCO3 poisoning in one family; three hospitalized patients displayed classic signs of barium toxicity, and one patient also developed rhabdomyolysis, respiratory failure, and hypophosphatemia. All patients survived. Rhabdomyolysis has not been previously reported in barium poisoning, and this is the first reported barium poisoning epidemic in the United States. The history, pathophysiology, and treatment of barium poisoning are reviewed.