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Barium is commonly utilized as a pesticide, a depilatory, and a radiographic contrast material. Acute exposures following ingestion or inhalation are most common outside the hospital setting. Exposures during radiologic procedures are associated with aspiration during oral studies, intravasation during rectal procedures, and iatrogenic intravenous administration. Rapid recognition is essential to address these potentially life-threatening exposures.

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Barium poisoning is a rare cause of exposure or poisoning as far fewer than 100 cases were reported to the AAPCC database in recent years (see Chap. 135). Toxicity is most commonly reported following the intentional ingestion of soluble salts found in rodenticides,9 insecticides, or depilatories.10 Barium carbonate has an appearance that is similar to flour and has been responsible for most unintentional barium poisonings.

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Barium salts and barium hydroxide are extensively employed in industry particularly in thermoplastics and the manufacture of synthetic fibers, soap manufacture, and in lubricants (see Table 109–1). Toxicity has also followed occupational exposure to barium salts through ingestion or inhalation. An explosion of the propellant barium styphnate caused extensive burns and trauma in a 50-year-old man. The individual also developed significant barium toxicity within 2 hours of exposure that persisted for at least 4 days.13 Despite the fact that barium sulfate is insoluble, rare cases of unintentional toxicity have been reported during radiographic procedures and include complications associated with oral20 and rectal administration.12,17,ch109rf19,ch109rf22 Toxicity and death occurred when soluble barium salts unintentionally contaminated contrast solution24 and flour.8

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Table 109–1. Barium Salts: Solubility and Common Usages
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Barium is a soft metallic element that was first isolated by Sir Humphry Davey in 1808. With an atomic weight of 137.3 barium is located at number 56 in the periodic table (between cesium and lanthanum). The metal oxidizes easily when exposed to water or ...

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