Seven Cases of Barium Carbonate Poisoning
Authors: G. Dean
Journal: BMJ (1950)

Seven patients were given barium carbonate for barium- meal investigations in December, 1948.Pure barium carbonate is a white powder exactly similar in appearance to barium sulphate and is commonly used as a rat poison.It had been placed by mistake in the barium sulphate container at the wholesale premises, and was therefore dispensed instead of barium sulphate in the preparation of the barium cream supplied to the radiologist.The quantity administered in all cases except the fatal one was a glassful, which was later shown to be equivalent to 4.26 oz.(133 g.) of dry barium carbonate.In the fatal case half this quantity was administered.Case Reports Case 1.-A healthy man aged 48 swallowed a chicken bone which lodged in his oesophagus.Forty hours later he was sent for x-ray examination.He swallowed half a glass of barium cream.The x-ray film confirmed the presence of the bone and he was admitted to hospital for its removal.An hour and a half after the barium swallow he was examined by the anaesthetist, who found him fit except for a raised blood pressure, 180/130, which was attributed to nervousness.While his throat was being sprayed with cocaine and adrenaline he vomited.He was given " omnopon," + gr.(22 mg.), and hyoscine, 1/100 gr.(0.65 g.).Half an hour later 0.7 g. of thiopentone and 8 mg. of " tubarine " were given.The bone was not impacted and was removed uneventfully.The patient recovered from the anaesthetic, and then started to vomit and purge; this was accompanied by severe griping abdominal pain, tenesmus, and the desire to micturate.He was very thirsty and soon began to complain of heaviness in his limbs and coldness.The vomiting ceased but the diarrhoea continued, he sweated profusely, and his pulse became thready and irregular; his temperature was normal and his mind clear.He was treated with warmth, hot drinks, intravenous glucose saline, nikethamide, adrenaline, and brandy.His pulse became imperceptible, and 11 hours after the operation and 13 hours after the barium, he died.At necropsy acid-soluble barium compound was found in the stomach, liver, and kidneys.The equivalent of 2.75 gr.(0.18 g.) of barium carbonate was recovercd from the stomach.Case 2.-This patient was given a full glass of barium cream (equivalent to 4 oz. of barium carbonate).An hour later he started to vomit and had diarrhoea with abdominal colic; his vision was blurred.He was taken to his family doctor, who found him shocked, cyanosed, and sweating, and able to move his limbs only with great difficulty.He complained of heavi- ness in the arms and legs, he could talk only in a whisper, his pulse was slow and irregular; his mind was clear.I was called in consultation and advised warmth, hot drinks, nikethamide, and a sedative.Eight hours after the barium he was still able to move his limbs only with great difficulty; he had no con- vulsions.His pulse was 90 and still irregular.An electro- cardiogram showed extrasystoles.His blood pressure was 160/100.The reflexes were all present but diminished; the Babinski responses were flexor.Twelve hours later he was improving, but remained in bed in the doctor's house extremely ill for over a week.Case 3.-A married woman aged about 30 was given a full glass of the cream.Within two hours her face felt stiff and her vision was blurred.A little later vomiting started, followed by diarrhoea and tenesmus.When examined three hours after the meal she was weak, cyanosed, and sweating; her mind was clear, and her pulse was grossly irregular.Her blood