Acute barium intoxication and hemodiafiltration.
We report a case of severe hypokalemia and flaccid muscle paralysis following a suicide attempt associating the calcium channel blocker amlodipine, the antidepressant fluoxetine and barium carbonate. Despite rapid correction of severe, life-threatening hypokalemia, areflexic quadriplegia persisted, suggesting a direct effect of barium on muscle cells. Continuous veno-venous hemodiafiltration (CVVHDF) was initiated. We determined barium concentration in the urine, plasma, and hemodiafiltrate during CVVHDF. We subsequently calculated the amounts of barium eliminated both by the CVVHDF and the kidneys. CVVHDF triples the measured barium elimination, reduced serum barium half-life by a factor of three, stabilized serum potassium levels, and rapidly improved motor strength, with complete neurological recovery within 24 h. Presentation and treatment of barium intoxication are discussed.
Koch
Marc
M
Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Brussels, Belgium. mkoch@ulb.ac.be
Appoloni
Olivier
O
Haufroid
Vincent
V
Vincent
Jean-Louis
JL
Lheureux
Philippe
P
D017311:Amlodipine / Q000506:poisoning; D001464:Barium / Q000097:blood / Q000506:poisoning* / Q000652:urine; D002121:Calcium Channel Blockers / Q000506:poisoning; D005260:Female; D017583:Hemodiafiltration; D006801:Humans; D007008:Hypokalemia / Q000139:chemically induced* / Q000628:therapy; D008875:Middle Aged; D011782:Quadriplegia / Q000139:chemically induced*; D013406:Suicide, Attempted; D016896:Treatment Outcome
D002121:Calcium Channel Blockers; D017311:Amlodipine; D001464:Barium