Acute barium chloride toxicity successfully treated with hemodialysis

Barium intoxication presents initially with vague gastrointestinal symptoms and paresthesia but can quickly progress to life-threatening hypokalemia and resultant paralysis, cardiac dysrhythmias, and death.

A 21-year-old male presented to the emergency department after ingestion of barium chloride/barium sulfate powder. The patient required intubation and aggressive potassium replacement at rates up to 60 mEq/h. Continuous veno-venous hemodiafiltration (CVVHDF) was initiated utilizing 4 mEq/L K (potassium) replacement fluid and was transitioned to 0 mEq/L K dialysate solution when hyperkalemia ensued. The patient's paralysis resolved and was able to be extubated 16 h after CVVHDF initiation.

The mainstay treatment of barium toxicity currently is supportive cares and decontamination. Dialysis can provide both chemical clearance and potassium regulation, mitigating the extracellular hypokalemia during the toxic phase and the expected rebound hyperkalemia. Dialysis should therefore be considered in severe cases of barium toxicity.