Outcomes of Extracorporeal Removal in Acute Barium Poisoning: A Scoping Review

Acute barium poisoning, though rare, can cause severe hypokalemia, respiratory paralysis, and life-threatening arrhythmias. Conventional treatments, including potassium replacement, may not rapidly resolve severe toxicity. Extracorporeal removal therapies (ECT), such as hemodialysis (HD) and continuous renal replacement therapy (CRRT), have been used to accelerate barium elimination, but their overall clinical outcomes remain unclear. This scoping review systematically summarizes current literature on the clinical outcomes of ECT in acute barium poisoning. We searched Embase, Ovid MEDLINE, and Cochrane Trials databases up to November 30, 2024. Fourteen articles reporting 15 cases were included. Most cases involved intentional oral ingestion, predominantly with barium chloride. Severe hypokalemia, respiratory paralysis, and serious arrhythmia were common. The overall survival rate was high (93.3%), with only one reported mortality. Toxicokinetic data showed that HD significantly reduced the elimination half-life of barium compared to non-dialysis approaches, while CRRT provided slower but sustained toxin removal. No ECT-related adverse events were reported. The findings highlight ECT as an effective method to manage severe barium poisoning symptoms. However, limited case data and publication bias indicate a need for larger comparative studies to determine optimal extracorporeal therapy strategies.