From profound hypokalemia to life-threatening hyperkalemia - A case of barium sulfide poisoning

We describe a 25-year-old man who was brought to the emergency department w ith skeletal muscle weakness, respiratory arrest, and rhabdomyolysis, as we ll as life-threatening hyperkalemia, after ingesting a depilatory containin g barium sulfide (Magic Shave; Carson Products Co, Savannah, Ga). The findi ngs of his physical examination were significant for hyporeflexia with mark ed weakness. He was in respiratory distress and required entubation and ven tilatory support owing to progressive weakness of the respiratory muscles. His serum potassium level was 1.5 mmol/L. He was treated with intravenous a nd oral potassium. His serum potassium level peaked at 8.3 mmol/L and his s erum creatine kinase level at 8286 IU/L. His acute respiratory weakness res olved with correction of the potassium concentration; his rhabdomyolysis re sponded well to hydration; and his renal function returned to normal. We al so discuss the various pathophysiological findings in this case and compare our patient with another who, despite ingesting a similar amount of the sa me hair remover, did not develop any of the above complications.