Barium sulfate

Cardiovascular

Electrocardiographic changes have been recorded during administration of barium enemas and could represent a hazard in cases of cardiac disease [ ].

Respiratory

Aspiration of barium sulfate into the lungs during barium meal examination can cause significant respiratory embarrassment, particularly in patients with poor respiratory function. It is recommended that water-soluble low-osmolar contrast media, which are less harmful, should be used instead of barium if there is a possibility of aspiration during examination of the upper gastrointestinal tract.

Aspiration of barium sulfate can cause obstruction of the small air passages, compromising respiratory function, and can cause inflammation in the bronchial tree and lung parenchyma [ ].

• A 68-year-old woman, with a history of alcohol abuse and a leiomyoma of the stomach, aspirated barium sulfate and became dyspneic and developed hypoxia (PaO2 46 mmHg). At bronchoscopy the bronchial mucosa was coated with barium and a chest X-ray showed heavy alveolar deposition of barium sulfate distributed over the entire lung, with some predominance in the lower zones. The patient developed a fever (39 °C) and a leukocytosis (12 × 10 ⁹ /l) the day after aspiration. She was given cefotiam 2000 mg and metronidazole 500 mg intravenously every 8 hours. The fever resolved within 2 days and Staphylococcus aureus was cultured from the bronchial fluid. She was discharged 2 days later, but the chest X-ray continued to show persistent alveolar deposition of the barium sulfate with only a slight improvement compared with the initial X-ray.

• A 60-year-old man with carcinoma of the hypopharynx aspirated barium into both lower lobes. He became hypoxic (PaO2 64 mmHg) and barium was extracted at bronchoscopy. He was given prophylactic antibiotics (cefotiam 2000 mg and metronidazole 500 mg intravenously every 8 hours for 4 days). A chest X-ray 6 days later showed residual barium deposition in the lower lobes. No further respiratory complications occurred.

The authors recommended that bronchoscopy should be performed early after aspiration to extract barium from the bronchial tree, and that prophylactic antibiotic therapy is important to prevent lung infection.