To the Editor:
In the recent issue of Clinical Toxicology you published an interesting paper on acute barium intoxication (J Toxicol Clin Toxicol 2003;41:363–367).
Some 15 years ago we had a similar case. A 17‐yr‐old boy presented unresponsive, requiring artificial respiration and cardiac defibrillation after ingesting 7 g of barium nitrate in a suicidal attempt. He was also incontinent of stool and urine due to paralyzed sphincters. His plasma potassium was 1.3–1.7 mM/L and remained below 2.0 mM/L despite vigorous I.V. supplementation. Haemodialysis was started using dialyzing fluid with 7.0 mM/L of potassium (roughly double the usual concentration). After 45 min his plasma potassium was 3.7 mM/L, he regained consciousness and could be extubated. Haemodialysis was continued up to 6h with the dialyzing fluid of regular potassium concentration.
At the start of haemodialysis his urine contained 5.7mg/mL of barium, a trace of it 4h later, and none at the end of haemodialysis. After 6h of dialysis he looked healthy and was transferred from the dialysis unit to our intensive care, which made him furious: he wanted to watch his favorite TV serial and unlike in the dialysis unit there was no TV in the intensive care. His convalescence was eventless.
I hope you may find this case interesting to your readers because of the effectiveness of haemodialysis in both removing the noxious barium and quickly supplementing the highly lacking potassium (and this was attained using dialyzing fluid with abnormally high potassium content).
Janusz Szajewski, M.D.
Szpital Praski
Warszawa, Poland