First, barium salt toxic effect barium sulfate is generally non-toxic, and soluble barium salts such as barium chloride, barium carbonate, barium nitrate on the human body is highly toxic, the amount of poisoning is 0.2~0.5g, lethal volume 0.8~30g[1, 2]. Acute poisoning is mainly caused by digestive tract absorption, after oral about 1h plasma concentrations reached a peak, 24h most of the transfer to muscle and bone . Barium salts have a strong and sustained stimulating effect on various muscles, and the excitability of myocardium makes the stress and conduction of myocardium stronger the heartbeat is accelerated, the severe time turns to suppress the heart muscle excited conduction, appears the bradycardia, the conduction block, the room and the atrial premature beat, the trachea smooth muscle contraction and even the convulsion, the vomiting, the abdominal pain, the diarrhea, the muscle fiber quiver convulsion, the movement obstacle , hypokalemia.
Second, potassium supplementation in the treatment of hypokalemia is the most important clinical manifestation of acute barium nitrate intoxication. Severe hypokalemia leads to respiratory muscle and myocardial paralysis, which is the main cause of death. Therefore, early and rapid improvement of blood potassium level is the key to rescue success. In this group of cases, the severity of the disease was positively correlated with the degree of hypokalemia, the lower the blood potassium and the heavier the disease. The method of potassium supplement for rescuing patients is: the first oral 10% potassium chloride 10~30ml, every 2h oral 1 times 10~20ml, blood potassium restored to normal after 10~15ml oral, 3 times a day. Severe cases or dysphagia, breathing machine users given gastric tube injection, while giving intravenous supplement potassium, 10% potassium chloride $number ml add saline 250~500ml static drip, 1.5~20g per hour, at the same time closely observe the blood potassium level and renal function, avoid the use of glucose and insulin to prevent potassium ions from outside the cell into the cell, the effect of potassium supplementation. Potassium supplementation can increase the concentration of potassium to $number. In the rescue process, except for L-inverted patients (potassium 1.2mmol/l) died from severe arrhythmia, 39 patients were recovered from the blood potassium and electrocardiogram in 2-5 days after hospitalization. The author believes that in the rescue of barium carbonate poisoning, active potassium supplementation is the key, oral potassium supplementation is safe and rapid, but intravenous potassium supplementation is also essential, closely monitoring blood potassium is very important.
Third, arrhythmia treatment for acute barium carbonate poisoning patients, arrhythmia is mainly caused by hypokalemia. After positive potassium therapy, arrhythmia can also be alleviated. For adequate potassium supplementation and arrhythmia to control, can be given antiarrhythmic drugs, ventricular early use of lidocaine 50~100mg intravenous, sinus slow can give isoproterenol.
IV. The use of antidotes in the rescue of barium nitrate poisoning, in addition to active potassium supplementation, but also need to use antidote. Sodium sulfate and sodium thiosulfate are all antidotes of barium carbonate. The patients in this group were treated with potassium supplements, most of the patients were relieved, some of the symptoms disappeared completely, but there were few patients with long duration of hypokalemia and the symptoms were not relieved. After the treatment with potassium sulfate, the symptoms of muscle paralysis including swallowing and breathing muscles were quickly relieved, arrhythmia corrected, and the level of blood potassium recovered quickly. Its action mechanism is the combination of sodium thiosulfate and barium ions to form the insoluble sulfur barium sulfate, which makes the barium ions inactive.