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3.10  POPULATIONS THAT ARE UNUSUALLY SUSCEPTIBLE 

A susceptible population will exhibit a different or enhanced response to barium than will most persons 

exposed to the same level of barium in the environment.  Reasons may include genetic makeup, age, 

health and nutritional status, and exposure to other toxic substances (e.g., cigarette smoke).  These 

parameters result in reduced detoxification or excretion of barium, or compromised function of organs 

affected by barium.  Populations who are at greater risk due to their unusually high exposure to barium 

are discussed in Section 6.7, Populations with Potentially High Exposures. 

The limited data available suggest that certain subgroups of the population may be more susceptible to 

barium exposure than the general population.  These include people with cardiovascular problems or lung 

disease, those taking certain prescription drugs, children, pregnant women, and smokers. 

Animal studies suggest that the kidney may be a sensitive target of barium toxicity; thus, individuals with 

impaired renal function may have a higher risk of developing barium-induced kidney damage.  There is 

suggestive evidence that barium may affect blood pressure.  Therefore, humans with hypertension could 

be at increased risk from either chronic, intermediate, or acute barium exposure.  Barbiturates have been 

shown to have an enhanced depressant effect on the heart in barium-exposed animals (Kopp et al. 1985; 

Perry et al. 1983, 1989).  Individuals on this type of medication may experience an increased risk of heart 

problems on exposure to barium. 

Since exposure to high doses of barium has been repeatedly demonstrated to significantly decrease serum 

potassium in both humans and animals (Foster et al. 1977; Gould et al. 1973; Phelan et al. 1984; Roza and 

Berman 1971), individuals taking diuretics may have a more severe hypokalemic reaction to barium 

toxicity. 

3.11  METHODS FOR REDUCING TOXIC EFFECTS  

This section will describe clinical practice and research concerning methods for reducing toxic effects of 

exposure to barium.  However, because some of the treatments discussed may be experimental and 

unproven, this section should not be used as a guide for treatment of exposures to barium.  When specific 

exposures have occurred, poison control centers and medical toxicologists should be consulted for  

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medical advice.  The following texts provide specific information about treatment following exposures to 

barium:   

Dreisbach RH, Robertson WO, eds.  1987.  Handbook of poisoning:  Prevention, diagnosis and treatment. 

12th ed.  Norwalk, CT:  Appleton & Lange, 119-120. 

Haddad LM, Winchester JF, eds.  1990.  Clinical management of poisoning and drug overdose.  2nd ed. 

Philadelphia, PA:  WB Saunders Company, 1129. 

3.11.1  Reducing Peak Absorption Following Exposure  

The general population is typically exposed to barium through consumption of food and drinking water; 

workers may also be exposed to barium via inhalation or dermal contact.  General recommendations for 

reducing absorption of barium following exposure have included removing the exposed individual from 

the contaminated area and removing contaminated clothing, followed by washing with mild soap and 

water.  If the eyes and skin were exposed, they are flushed with water.  Lavage or emesis has also been 

suggested; however, high concentrations of barium cause nausea and emesis should not be induced in 

cases where substantial vomiting has already occurred (Haddad and Winchester 1990).  Furthermore, 

there is a risk of aspiration of vomitus during emesis.  Administration of soluble sulfates orally will also 

limit absorption of barium by causing precipitation of an insoluble form of barium (barium sulfate) 

(Dreisbach and Robertson 1987; Haddad and Winchester 1990).  However, intravenous administration of 

sulfate salts should be avoided because barium precipitate in the kidneys will cause renal failure 

(Dreisbach and Robertson 1987; Koch et al. 2003).  

3.11.2  Reducing Body Burden  

Barium is primarily distributed to the bone and teeth; it is not known if the barium distributed to these 

tissues would result in toxicity.  A method for reducing the levels of barium in bone and teeth has not 

been identified.  Removal of barium from the bloodstream may be facilitated by infusing with saline and 

inducing saline diuresis (Dreisbach and Robertson 1987).  As described in several case reports of barium 

poisoning (Bahlmann et al. 2005; Koch et al. 2003; Thomas et al. 1998; Wells and Wood 2001), 

hemodialysis resulted in significant decreases in the levels of barium in the blood and improved clinical 

signs. 

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3.11.3  Interfering with the Mechanism of Action for Toxic Effects  

Hypokalemia is commonly seen in cases of acute barium toxicity and may be responsible for some of the 

symptoms of barium poisoning (Proctor et al. 1988).  Plasma potassium should be monitored and 

hypokalemia may be relieved by intravenous infusion of potassium (Dreisbach and Robertson 1987; 

Haddad and Winchester 1990; Proctor et al. 1988). 

3.12  ADEQUACY OF THE DATABASE 

Section 104(I)(5) of CERCLA, as amended, directs the Administrator of ATSDR (in consultation with the 

Administrator of EPA and agencies and programs of the Public Health Service) to assess whether 

adequate information on the health effects of barium and compounds is available.  Where adequate 

information is not available, ATSDR, in conjunction with the National Toxicology Program (NTP), is 

required to assure the initiation of a program of research designed to determine the health effects (and 

techniques for developing methods to determine such health effects) of barium and compounds. 

The following categories of possible data needs have been identified by a joint team of scientists from 

ATSDR, NTP, and EPA.  They are defined as substance-specific informational needs that if met would 

reduce the uncertainties of human health assessment.  This definition should not be interpreted to mean 

that all data needs discussed in this section must be filled.  In the future, the identified data needs will be 

evaluated and prioritized, and a substance-specific research agenda will be proposed. 

3.12.1  Existing Information on Health Effects of Barium and Barium Compounds 

The existing data on health effects of inhalation, oral, and dermal exposure of humans and animals to 

barium and barium compounds are summarized in Figure 3-3.  The purpose of this figure is to illustrate 

the existing information concerning the health effects of barium.  Each dot in the figure indicates that one 

or more studies provide information associated with that particular effect.  The dot does not necessarily 

imply anything about the quality of the study or studies, nor should missing information in this figure be 

interpreted as a “data need”.  A data need, as defined in ATSDR’s Decision Guide for Identifying 

Substance-Specific Data Needs Related to Toxicological Profiles (Agency for Toxic Substances and 

Disease Registry 1989), is substance-specific information necessary to conduct comprehensive public 

health assessments.  Generally, ATSDR defines a data gap more broadly as any substance-specific 

information missing from the scientific literature. 

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