ACUTE BARIUM INTOXICATION

A 45-year-old man attempted to commit suicid by ingesting a large amou nt of barium. In some hours, he experienced generalized muscle weaknes s with hypokalaemia, treated by large dose of potassium (440 mmol in t he first day). This weakness resulted in difficulties in swallowing an d respiratory failure requiring mechanical vcntilation. An anuric rena l insufficiency started early, requiring haemodialysis for three weeks . It was induced probably by renal toxicity of barium and recovered co mpletely. Later, the patient experienced an extrapyramidal syndrome in itiated by tremor and myoclonia. Hypertonia induced a parkinsonian rhe umatism, fixing the two hands in an irreductible position. There was a lso a contracture of superior sphincter of oesophagus, with severe dis turbance of deglutition, ending after three months only. MRI study sho wed a bilateral hypersignal in basal ganglia and thalamus. It remains unknown whether this neurological syndrome was toxic or ischaemic. Thi s patient remained under mechanical ventilation for three months becau se of disturbances of deglutition. He was discharged to his home at th e 6th month. One year later he was still adynamic, but able to carry o ur rather precise movements.