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J Med Toxicol. 2009 December; 5(4): 209–213.
PMCID: PMC2845971

Acute barium toxicity from ingestion of “snake” fireworks

Sean H. Rhyee, MD, MPHcorresponding author and Kennon Heard, MD



Ingestion of fireworks has been infrequently reported in the medical literature. We describe a case of acute barium poisoning following firework ingestion.

Case Report

A 35-year-old male with a history of severe mental retardation presented with vomiting and diarrhea following ingestion of 16 small fireworks (“color snakes” and “black snakes”). His condition rapidly deteriorated and he developed obtundation, wide complex dysrhythmias, and respiratory failure. Approximately 12 hours following ingestion, his serum potassium level was 1.5 mmol/L with a serum barium level of 20,200 μg/mL (reference range<200 μg/L). The patient eventually recovered with ventilatory support and potassium supplementation.


Although firework ingestion is uncommon, clinicians should be prepared for potentially severe complications. In the case of barium poisoning, treatment consists of potassium supplementation, along with respiratory and hemodynamic support.

Keywords: fireworks, barium, hypokalemia

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
1. Witsaman RJ, Comstock RD, Smith GA. Pediatric fireworks-related injuries in the United States: 1990–2003. Pediatrics. 2006;118:296–303. doi: 10.1542/peds.2006-0790. [PubMed] [Cross Ref]
2. Centers for Disease Control and Prevention Injuries from fireworks in the United States. MMWR. 2000;49:545–546. [PubMed]
3. Brayer AF, Callahan CM, Wax PM. Acute arsenic poisoning from ingestion of “snakes” Pediatr Emerg Care. 1997;13:394–396. doi: 10.1097/00006565-199712000-00010. [PubMed] [Cross Ref]
4. Tafur AJ, Zapatier JA, Idrovo LA, et al. Bone marrow toxicity after yellow phosphorus ingestion. Emerg Med J. 2004;21:259–260. doi: 10.1136/emj.2003.007880. [PMC free article] [PubMed] [Cross Ref]
5. Koch M, Appoloni O, Haufroid V, et al. Acute barium intoxication and hemodiafiltration. J Toxicol/Clin Toxicol. 2003;41:363–367. [PubMed]
6. Jacobs IA, Taddeo J, Kelly K, et al. Poisoning as a result of barium styphnate explosion. Am J Ind Med. 2002;41:285–288. doi: 10.1002/ajim.10056. [PubMed] [Cross Ref]
7. Sigue G, Gamble L, Pelitere M, et al. From profound hypokalemia to life-threatening hyperkalemia. Arch Intern Med. 2000;160:548–551. doi: 10.1001/archinte.160.4.548. [PubMed] [Cross Ref]
8. Schorn TF, Olbricht C, Schuler A, et al. Barium carbonate intoxication. Intensive Care Med. 1991;17:60–62. doi: 10.1007/BF01708412. [PubMed] [Cross Ref]
9. Downs JC, Milling D, Nichols Clay A. Suicidal ingestion of barium-sulfide-containing shaving powder. Am J Forensic Med Pathol. 1995;16:56–61. doi: 10.1097/00000433-199503000-00013. [PubMed] [Cross Ref]
10. Johnson CH, Van Tassell VJ. Acute barium poisoning with respiratory failure and rhabdomyolysis. Ann Emerg Med. 1991;20:1138–1142. doi: 10.1016/S0196-0644(05)81393-9. [PubMed] [Cross Ref]
11. Sperelakis N, Schneider MF, Harris EJ. Decreased K+ conductance produced by Ba++ in frog sartorius fibers. J Gen Physiol. 1967;50:1565–1583. doi: 10.1085/jgp.50.6.1565. [PMC free article] [PubMed] [Cross Ref]
12. Volle RL. Blockade by barium of potassium fluxes in frog sartorius muscle. Life Sci. 1970;9:175–180. doi: 10.1016/0024-3205(70)90362-0. [PubMed] [Cross Ref]
13. Nagel W. Inhibition of potassium conductance by barium in frog skin epithelium. Biochem Biophys Acta. 1979;552:346–357. doi: 10.1016/0005-2736(79)90289-X. [PubMed] [Cross Ref]
14. Roza O, Berman LB. The pathophysiology of barium: hypokalemic and cardiovascular effects. J Pharmacol Exp Ther. 1971;177:433–439. [PubMed]
15. Brautbar N, Altura BM. Hypophosphatemia and hypomagnesemia result in cardiovascular dysfunction: theoretical basis for alcohol-induced cellular injury. Alcohol Clin Exp Res. 1987;11:118–126. doi: 10.1111/j.1530-0277.1987.tb01274.x. [PubMed] [Cross Ref]
16. Wells JA, Wood KE. Acute barium poisoning treated with hemodialysis. Am J Emerg Med. 2001;19:175–177. doi: 10.1053/ajem.2001.21332. [PubMed] [Cross Ref]

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