Baryta Carbonica: A Toxic Compound with Severe Health Risks
Baryta carbonica (barium carbonate) is a highly toxic alkaline earth metal compound that can cause life-threatening poisoning with severe hypokalemia, muscle paralysis, cardiac arrhythmias, and respiratory failure when ingested. 1, 2
Chemical Properties and Uses
- Baryta carbonica is a chemical compound composed of barium and carbonate (BaCO₃) that is highly toxic to humans when ingested 1
- It is commonly used as a rodenticide and in some industrial processes including ceramic glazes 2, 3
- The compound appears as a white powder that can be mistaken for flour or other cooking ingredients, leading to accidental poisoning 1
Mechanism of Toxicity
- Barium targets potassium inward rectifier channels (IRCs) in cell membranes 3
- It blocks potassium channels by entering and binding to the potassium selectivity filter region, preventing normal potassium flow 3
- This blockage leads to profound hypokalemia (serum potassium <2.5 mM) as potassium shifts intracellularly 3
- Severe hypokalemia occurs at barium serum concentrations ≥0.0025 mM 3
Clinical Presentation of Barium Carbonate Poisoning
Gastrointestinal Symptoms (Early)
- Vomiting and diarrhea typically occur within 1-2 hours of ingestion 1, 4
- Abdominal pain and cramping are common early symptoms 1
Neuromuscular Symptoms
- Progressive muscle weakness, often beginning in proximal limbs 2
- Paralysis that can progress to respiratory failure 1, 5
- Abnormal reflexes and generalized paresthesia 1
- Carpopedal spasm may be observed 1
Cardiovascular Manifestations
- Cardiac arrhythmias, including ventricular extrasystoles 3
- ECG changes including prolonged QT interval, ST changes, and prominent U waves 2, 3
- Hypertension may occur in some cases 3
Metabolic Abnormalities
- Severe hypokalemia is the hallmark finding 1, 2, 3
- Elevated creatine kinase indicating muscle damage 1
- Hypophosphatemia may occur 5
- Acute kidney injury can develop 2, 4
Management of Barium Carbonate Poisoning
Immediate Interventions
- Aggressive intravenous potassium supplementation is the cornerstone of treatment 1, 2, 3
- Monitor for rebound hyperkalemia as treatment progresses 2
- Provide respiratory support, including mechanical ventilation if needed 1, 5
Decontamination
- Gastric lavage if the patient presents early after ingestion 3
- Administration of oral sulfates to form insoluble barium sulfate in the intestinal tract 3
- Consider endoscopic removal if radiopaque material is visible on imaging 2
Advanced Measures
- Continuous veno-venous hemodialysis (CVVHD) may be beneficial for enhanced elimination of barium in severe cases 2
- Cardiac monitoring and management of arrhythmias 3
Prognosis and Mortality
- Mortality rate can be high (12% reported in one case series) without prompt treatment 1
- Death typically occurs from respiratory failure or cardiac arrhythmias 1, 4
- Patients who survive the acute phase generally recover completely, though kidney function may take time to normalize 2
Prevention
- Restrict availability of barium carbonate, especially in household settings 1
- Store rodenticides and other toxic compounds away from food preparation areas 1
- Proper labeling of all toxic substances is essential 1
Important Considerations
- Barium carbonate poisoning represents a medical emergency requiring immediate intervention 1, 2, 3
- The rapid development of symptoms and potential for fatal outcome necessitates prompt recognition and treatment 1
- Healthcare facilities in resource-limited settings may struggle to manage multiple simultaneous cases of barium poisoning 1