Suicide by an Unusual Compound: A Case of Barium Acetate Toxicity.

ABSTRACT: Forensic pathologists may sometimes encounter cases of suicide with ingestion of unusual compounds. Herein, we describe a case of suicide by ingestion of barium acetate. Deaths by ingestion of this compound have not previously been reported in literature. This case shows the clinical presentation of the toxicity of barium compounds and highlights the importance of scene investigation and clinicopathologic correlation in suicides by unusual ingestion.

Barium determination in gastric contents, blood and urine by inductively coupled plasma mass spectrometry in the case of oral barium chloride poisoning.

A serious case of barium intoxication from suicidal ingestion is reported. Oral barium chloride poisoning with hypokalemia, neuromuscular and cardiac toxicity, treated with intravenous potassium supplementation and hemodialysis, was confirmed by the determination of barium concentrations in gastric contents, blood, serum and urine using the inductively coupled plasma mass spectrometry method. Barium concentrations in the analyzed specimens were 20.45 µg/L in serum, 150 µg/L in blood, 10,500 µg/L in urine and 63,500 µg/L in gastric contents. Results were compared with barium levels obtained from a non-intoxicated person.

Fatal barium chloride poisoning: four cases report and literature review.

Barium is an alkaline earth metal which has a variety of uses including in the manufacturing industry and in medicine. However, adverse health effects and fatalities occur due to absorption of soluble barium compounds, notably the chloride, nitrate, and hydroxide, which are toxic to humans. Although rare, accidental and suicidal modes of poisoning are sporadically reported in the literature.We describe 4 cases of poisoning due to barium chloride in China. In witnessed cases, severe gastrointestinal symptoms, hypokalemia leading to muscle weakness, cardiac arrhythmias, and respiratory failure were noted. Autopsy showed some nonspecific but common findings, such as subendocardial hemorrhage in the ventricles, visceral petechiae, and fatty changes in the liver. Interestingly, microscopic examination showed degenerative changes and amorphous, flocculent foamy materials in the renal tubules. Toxicology was relevant for barium in blood and tissues. Three of the cases were accidental and 1 homicidal in nature. A round-up of relevant literature on fatal barium compounds poisoning is also provided. Forensic pathologists should be aware of the clinical presentations of barium compound poisoning and especially look for any evidence of hypokalemia. Still, postmortem toxicological and histological studies are essential for an accurate identification of the cause of death.

Intoxication by large amounts of barium nitrate overcome by early massive K supplementation and oral administration of magnesium sulphate.

Suicide by ingestion of barium is exceptionally rare. Adverse health effects depend on the solubility of the barium compound. Severe hypokalemia, which generally occurs within 2 hours after ingestion, is the predominating feature of acute barium toxicity, subsequently leading to adverse effects on muscular activity and cardiac automaticity. We report one case of acute poisoning with barium nitrate, a soluble barium compound. A 75-year-old woman was hospitalized after suicidal ingestion of a burrow mole fumigant containing 12.375 g of barium nitrate. About 1 hour post-ingestion, she was only complaining of abdominal pain. The ECG recording demonstrated polymorphic ventricular premature complexes (VPCs). Laboratory data revealed profound hypokalemia (2.1 mmol/L). She made a complete and uneventful recovery after early and massive potassium supplementation combined with oral magnesium sulphate to prevent barium nitrate absorption.

[Acute poisoning due to barium chloride--case report]. / Ostre zatrucie chlorkiem baru--opis przypadku.

We reported a case of 52-years-old male, suffering from alcohol dependence, who ingested 20-30 ml 10% barium chloride solution as a substitute of ethanol. We observed gastrointestinal disturbances (nausea, vomiting, diarrhea), numbness and paresthesias of limbs, severe hypokalemia (1.29 mmol/l) resulting in general paralysis of skeleton muscles, dysarthria and dysphagia, ventricular arrhythmias. This patient was treated successfully with potassium chloride supplementation and was discharged after 9 days.

Acute barium nitrate intoxication treated by hemodialysis.

A 22-year-old male was admitted to hospital with diarrhea and vomiting, cardiac arrhythmias, severe hypokalemia and gradual onset of muscular weakness. A potassium infusion was started, but for several hours serum potassium remained low. Evidence of toxic ingestion was initially lacking. When it became clear -- after a considerable delay -- that the patient had ingested barium nitrate, hemodialysis was started. This resulted in rapid clinical improvement with correction of hypokalemia and restored muscular function. Intoxication with barium causes hypokalemia, arrhythmias, muscular weakness and paralysis, often requiring respiratory support. This patient presented with symptoms typical of severe barium intoxication, non-responsive to potassium supplementation. There are few published reports on the use of hemodialysis in barium poisoning. This case confirms the possible benefit of hemodialysis in severe cases, where potassium supplementation alone is insufficient.

Barium toxicity after exposure to contaminated contrast solution--Goias State, Brazil, 2003.

Barium-containing contrast solutions are commonly used in radiologic studies. On May 22, 2003, three patients at radiology clinics in Goias State, Brazil, were hospitalized after ingesting such solutions; two persons died within 24 hours of hospitalization. Exposure occurred during radiologic examination of the upper or lower gastrointestinal tract. An investigation was conducted by municipal and state public health authorities with assistance from the Ministry of Health's National Agency for Sanitary Surveillance (ANVISA) and Brazil's Field Epidemiology Training Program (FETP), known locally as EPISUS. This report summarizes the results of that investigation, which found that 44 persons had suspected barium toxicity, nine of whom died. Eight of the nine deaths were linked to a single lot of brand A contrast solution. A national recall was announced on May 23, and the manufacturing facility was inspected and closed. Clinicians should be alert for signs of barium toxicity in patients in the hours after administration of contrast solutions during radiologic studies.

Suicidal poisoning with barium chloride.

A 49-year-old male pharmacist suffering from depression phoned the emergency services telling of how he had ingested barium chloride. He was found semicomatose in bed and resuscitation attempts were to no avail and he died at the scene. A white plastic container labelled "Barium chloride... Poison", and a book with a writing on a blank page... "give sulphate... SO(4)" were found. At autopsy, 1l of whitish-yellow fluid was found in the stomach. Autopsy barium levels were: blood 9.9mg/l; bile 8.8mg/l; urine 6.3mg/l; gastric 10.0g/l. Cause of death was given as cardiorespiratory arrest due to barium chloride poisoning. The issue of barium toxicity in a variety of itatrogenic and non itatrogenic situation is discussed together with the two only other cases of suicidal barium ingestion, and the feasibility of early intervention at the scene by an emergency team.

[Bioavailability and bone toxicity of barium chloride by chronic administration in rats]. / Biodisponibilité et toxicité osseuse du chlorure de baryum en administration chronique chez le rat.

Knowing long term total parenteral nutrition (TPN) can bring 12 micrograms/kg/day as barium contamination, we investigated the barium ability to give the same bone toxicity as observed in patients' underlying TPN. A preliminary study carried out on 21 rats allowed us to calculate the bioavailability of barium chloride (50%) with doses fixed at 1 mg/kg for the intravenous route and 10 mg/kg for the oral route. As it is very difficult to feed rats parenterally for more than 30 days, we decided to give barium chloride orally. Twenty rats received 48 micrograms/kg/day barium chloride during 4 months. The barium plasma and bone levels were not statistically different between the control group and the tested group. The femurs and tibias were removed for analysis, carried out by different fixation and coloration techniques. No anomalies could be detected in the treated group concerning main bone parameters that are disturbed in patients' underlying TPN.

Suicidal ingestion of barium-sulfide-containing shaving powder.

Physicians, familiar with the common usage of barium medicinally as the contrast agent barium sulfate, may consider it an innocuous or at most a minimally harmful compound. The barium cation is extremely toxic and produces characteristic gastrointestinal symptoms, periorbital and extremity paresthesia, hypertension, and progressive flaccid muscular paralysis. Profound hypokalemia also may be induced. Overdose may be rapidly fatal unless the ingestion is recognized and appropriate treatment is instituted expediently.

[Voluntary barium poisoning]. / Intoxication volontaire par le baryum.

A 45-year-old man attempted to commit suicide by ingesting a large amount of barium. In some hours, he experienced generalized muscle weakness with hypokalaemia, treated by large dose of potassium (440 mmol in the first day). This weakness resulted in difficulties in swallowing and respiratory failure requiring mechanical ventilation. An anuric renal insufficiency started early, requiring haemodialysis for three weeks. It was induced probably by renal toxicity of barium and recovered completely. Later, the patient experienced an extrapyramidal syndrome initiated by tremor and myoclonia. Hypertonia induced a parkinsonian rheumatism, fixing the two hands in an irreducible position. There was also a contracture of superior sphincter of oesophagus, with severe disturbance of deglutition, ending after three months only. MRI study showed a bilateral hypersignal in basal ganglia and thalamus. It remains unknown whether this neurological syndrome was toxic or ischaemic. This patient remained under mechanical ventilation for three months because of disturbances of deglutition. He was discharged to his home at the 6th month. One year later he was still adynamic, but able to carry our rather precise movements.