title: Acute barium toxicity from ingestion of "snake" fireworks.
abstract: BACKGROUND
  Ingestion of fireworks has been infrequently reported in the medical literature. We describe a case of acute barium poisoning following firework ingestion.
  
  
  METHODS
  A 35-year-old male with a history of severe mental retardation presented with vomiting and diarrhea following ingestion of 16 small fireworks ("color snakes" and "black snakes"). His condition rapidly deteriorated and he developed obtundation, wide complex dysrhythmias, and respiratory failure. Approximately 12 hours following ingestion, his serum potassium level was 1.5 mmol/L with a serum barium level of 20,200 microg/mL (reference range <200 microg/L). The patient eventually recovered with ventilatory support and potassium supplementation.
  
  
  CONCLUSIONS
  Although firework ingestion is uncommon, clinicians should be prepared for potentially severe complications. In the case of barium poisoning, treatment consists of potassium supplementation, along with respiratory and hemodynamic support.
authors.affiliation: Department of Emergency Medicine, Division of Medical Toxicology, University of Massachusetts Medical School, Worcester, MA 01655, USA. rhyees@umassmemorial.org
authors.forename: Sean H
authors.initials: SH
authors.lastname: Rhyee
authors.forename: Kennon
authors.initials: K
authors.lastname: Heard
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000139:chemically induced / Q000628:therapy; D001464:Barium / Q000097:blood / Q000506:poisoning*; D003131:Combined Modality Therapy; D003967:Diarrhea / Q000139:chemically induced / Q000628:therapy; D004562:Electrocardiography; D053834:Explosive Agents / Q000097:blood / Q000506:poisoning*; D005751:Gastric Lavage; D006801:Humans; D007008:Hypokalemia / Q000097:blood / Q000139:chemically induced* / Q000628:therapy; D008607:Intellectual Disability; D008297:Male; D011188:Potassium / Q000097:blood / Q000627:therapeutic use; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000628:therapy; D016896:Treatment Outcome; D014839:Vomiting / Q000139:chemically induced / Q000628:therapy
chemical_list: D053834:Explosive Agents; D001464:Barium; D011188:Potassium