Barium, a heavy divalent alkaline
metal, has long been known to cause human toxicity. The common mode is accidental ingestion and the common compound is
Barium carbonate. Here we report an incident of
food poisoning in 27 law enforcement personnel with rapidly developing sequelae and a high mortality due to ingestion of
Barium carbonate contaminated flour.
CASE PRESENTATION: One midnight, 27 adult males were rushed to emergency department of Chittagong Medical College Hospital with
abdominal pain,
vomiting, loose motion,
cramps and generalized paraesthesia. The ailment started 1-2 hours after Iftar (evening meal to break day long fast during Ramadan) which included fried vegetables coated with a flour
paste. On admission, twenty of them were restless, agitated. 22 reported weakness of limbs and were unable to walk. 10 had
hypotension. 22 had rapid and shallow respiration. 5 had carpopedal
spasm. Different grades of limb weakness were noted with loss of tendon jerks. Ten (N12) patients had hypokalaemia, three had hypoglycaemia, 4 patients had high
creatine kinase. Electrocardiogram showed flat ST with U waves in 4 patients.
Potassium containing intravenous fluid and
Oxygen was administered. Due to limited availability of
mechanical ventilators patients were put on
artificial respiration using Ambu bag; manually maintained by doctors, paramedics and attendants. Four patients were transferred to another hospital for
mechanical ventilation. A total of 12 patients died over next 16 hours, 4 within 3 hrs. Other patients gradually improved. Chemical analysis of the vomitus, blood and flour used for preparation of meal revealed the presence of
Barium. It was assumed that the flour was contaminated with the similar looking
Barium carbonate powder which was kept in the kitchen as a
rodenticide.
CONCLUSION: This event exemplifies the weakness of usual health care facility in resource poor settings to cope with this kind of massive
poisoning event. The multiple reported incidences of accidental
Barium poisoning due to unintentional mixing with food signifies the fact that the use and availability of
Barium carbonate should be restricted. We hope to draw attention to this relatively uncommon
poisoning and to the need for development of
poison information centre in resource poor countries.