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Fatal Barium Chloride Poisoning: Four Cases Report and Literature Review

Ananda, Sunnassee MBBS, MD*; Shaohua, Zhu MD, PhD*; Liang, Liu PhD*†

The American Journal of Forensic Medicine and Pathology: June 2013 - Volume 34 - Issue 2 - p 115–118
doi: 10.1097/PAF.0b013e31828a2626
Case Reports

Barium is an alkaline earth metal which has a variety of uses including in the manufacturing industry and in medicine. However, adverse health effects and fatalities occur due to absorption of soluble barium compounds, notably the chloride, nitrate, and hydroxide, which are toxic to humans. Although rare, accidental and suicidal modes of poisoning are sporadically reported in the literature.

We describe 4 cases of poisoning due to barium chloride in China. In witnessed cases, severe gastrointestinal symptoms, hypokalemia leading to muscle weakness, cardiac arrhythmias, and respiratory failure were noted. Autopsy showed some nonspecific but common findings, such as subendocardial hemorrhage in the ventricles, visceral petechiae, and fatty changes in the liver. Interestingly, microscopic examination showed degenerative changes and amorphous, flocculent foamy materials in the renal tubules. Toxicology was relevant for barium in blood and tissues. Three of the cases were accidental and 1 homicidal in nature. A round-up of relevant literature on fatal barium compounds poisoning is also provided. Forensic pathologists should be aware of the clinical presentations of barium compound poisoning and especially look for any evidence of hypokalemia. Still, postmortem toxicological and histological studies are essential for an accurate identification of the cause of death.

From the *Department of Forensic Medicine, Huazhong University of Science and Technology, Tongji Medical College, Wuhan, Hubei; and †Key Laboratory of Evidence Science, China University of Political Science and Law, Ministry of Education, Beijing, People’s Republic China.

Manuscript received June 12, 2012; accepted October 18, 2012.

The authors report no conflicts of interest.

Reprints: Zhu Shaohua, MD, PhD, Department of Forensic Medicine, Huazhong University of Science and Technology, Tongji Medical College, Hang Kong Lu, Wuhan 430030, Hubei, People’s Republic China. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.