Elementary, my dear Dr. Allen: the case of barium toxicity and Pa Ping.
OBJECTIVE
We aimed to review the English and Chinese literature on Pa Ping and to confirm by personal interview the story of how its pathogenesis was uncovered.


BACKGROUND
In 1930, Dr. Alexander Stewart Allen noticed a pattern of illness arising in the region of Kiating, China. Area residents began presenting to local hospitals with nausea, vomiting, and diarrhea, and what emerged was a clinical picture of a gradual ascending paralysis that could result in death, termed Pa Ping. All 3 patients observed by Dr. Allen were male, had no family history of the disease, and had recently eaten before the onset of paralysis. Pa Ping developed in Dr. Allen himself, but he survived.


METHODS
Medical literature was reviewed for primary sources. Interviews of living descendants and friends of the doctors in China and North America were conducted and information was corroborated by written records.


RESULTS
Dr. Huang, with the National Central University College of Medicine, noticed a striking similarity between Pa Ping and familial periodic paralysis in 12 patients and reported 2 patients with Pa Ping treated with potassium citrate who experienced a reversal of the paralysis. Dr. K.T. Du analyzed meals of patients with Pa Ping seen by Dr. Zhe Tung and found barium in concentrations as high as 25.7%. This finding was confirmed by administering barium chloride to animals, which recapitulated the human syndrome.


CONCLUSIONS
Although Dr. Huang had correctly noticed an underlying potassium depletion in patients with Pa Ping, the observations of Dr. Zhe Tung and Dr. K.T. Du ultimately established barium-induced hypokalemia as the underlying cause.
Bowen
L N
LN
Department of Neurology, Movement Disorders Center, University of Florida College of Medicine, FL, USA. lauren.bowen@ufl.edu
Subramony
S H
SH
Cheng
J
J
Wu
S S
SS
Okun
M S
MS
D001464:Barium / Q000506:poisoning*; D002490:Central Nervous System / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D002681:China; D018450:Disease Progression; D004781:Environmental Exposure / Q000009:adverse effects; D005506:Food Contamination / Q000517:prevention & control; D049673:History, 20th Century; D006801:Humans; D018908:Muscle Weakness / Q000139:chemically induced / Q000266:history / Q000503:physiopathology; D020258:Neurotoxicity Syndromes / Q000209:etiology* / Q000266:history; D010243:Paralysis / Q000139:chemically induced* / Q000266:history; D011191:Potassium Deficiency / Q000139:chemically induced* / Q000266:history / Q000503:physiopathology; D012133:Respiratory Paralysis / Q000139:chemically induced / Q000266:history / Q000503:physiopathology; D017673:Sodium Chloride, Dietary / Q000138:chemical synthesis / Q000506:poisoning
D017673:Sodium Chloride, Dietary; D001464:Barium