Toxicological Review of Barium and Compounds

in the drinking water of the two communities were stated to be similar.  Subjects were selected 

randomly from a pool that included every person 18 years of age or older.  The response rate is 

unknown.  All subjects underwent three blood pressure measurements (taken over a 20-minute 

period with a calibrated electronic blood pressure apparatus) and responded to a health 

questionnaire that included such variables as sex, age, weight, height, smoking habits, family 

history, occupation, medication, and physician-diagnosed heart disease, stroke, and renal disease. 

Data were evaluated by analysis of variance and adjusted for age and sex.  The West Dundee 

study population included 506 males and 669 females.  The McHenry study population included 

532 males and 671 females.  The ages of both populations ranged from 18 to 75 and older.  

No significant differences in mean systolic or diastolic blood pressures or in rates of 

hypertension, heart disease, stroke, or kidney disease were observed between the two 

communities.  Since no differences were observed between the populations of these two 

communities, a subpopulation of the McHenry and West Dundee subjects who did not have 

home water softeners, were not taking medication for hypertension, and had lived in the study 

community for more than 10 years was evaluated.  There were 85 subjects from each community 

in this subpopulation.  No significant differences were observed between these two 

subpopulations for any of the endpoints measured. 

4.1.2.  Case Reports Following Oral Exposure 

There are numerous case reports of accidental or intentional ingestion of soluble barium 

salts (Centers for Disease Control [CDC], 2003; Koch et al., 2003; Jacobs et al., 2002; Jourdan et 

al., 2001; Koley et al., 2001; Thomas et al., 1998; Downs et al., 1995; Deng et al., 1991; Jan et 

al., 1991; Schorn et al., 1991; Dhamija et al., 1990; Tenenbein, 1985).  Reported effects included 

gastroenteritis, hypokalemia, acute hypertension, cardiac arrhythmia, skeletal muscle paralysis, 

and death (CDC, 2003; Jacobs et al., 2002; Deng et al., 1991; Schorn et al., 1991; Roza and 

Berman, 1971).  Acute renal failure was reported in a case of barium poisoning in which the 

patient was treated with intravenous sulfate (Wetherill et al., 1981).  The patient had been “spree 

drinking” laboratory ethanol over the course of a week and then ingested approximately 13 g of 

barium chloride with suicidal intent.  Eight hours after ingestion of the barium salt, the patient 

experienced progressive paralysis and was treated with oral and intravenous magnesium sulfate 

and potassium replacement.  Barium serum concentrations were not measured.  On the third 

hospital day, urine output dropped despite forced diuresis, and blood urea nitrogen (BUN) and 

creatinine levels rose dramatically.  Renal tubular cells and granular casts were recovered from 

urine sediment.  Nephrotomograms detected curvilinear barium deposition in the renal calyceal 

11

---

system, which resolved over the course of a week.  Acute tubular necrosis was apparently caused 

by precipitated barium sulfate, which obstructed the renal tubules. 

4.1.3.  Inhalation Exposure 

The data base on the toxicity of inhaled barium compounds in humans consists primarily 

of studies of occupational exposure to barium sulfate or barite ore or to unspecified soluble 

barium compounds.  Several case reports (e.g., Seaton et al., 1986; Pendergrass and Greening, 

1953) and a prospective study conducted by Doig (1976) have reported baritosis in barium-

exposed workers.  Baritosis is considered a benign pneumoconiosis resulting from the inhalation 

of barite ore or barium sulfate.  The most outstanding feature of baritosis is the intense 

radiopacity of the discrete opacities that are usually profusely disseminated throughout the lung 

fields; in some cases the opacities may be so numerous that they appear confluent.  The Third 

Conference of Experts on Pneumoconiosis (American Conference of Governmental Industrial 

Hygienists [ACGIH], 1992) noted that barium sulfate produced a noncollagenous type of 

pneumoconiosis in which there is a minimal stromal reaction that consists mainly of reticulin 

fibers, intact alveolar architecture, and potentially reversible lesions.  The available human data 

on baritosis suggest that the accumulation of barium in the lungs does not result in medical 

disability or symptomatology.  A decline in the profusion and opacity density, suggesting a 

decrease in the amount of accumulated barium in the lung, has been observed several years after 

termination of exposure.  Studies by the National Institute for Occupational Safety and Health 

(NIOSH, 1982) and Zschiesche et al. (1992) on soluble barium compounds did not include 

radiography; these studies focused on the potential for barium to induce systemic effects (e.g., 

increases in blood pressure, kidney effects, electrocardiogram [EKG] alterations). 

Doig (1976) conducted a prospective study on workers at a barite grinding facility. 

During the initial investigation in 1947, five workers employed for more than 3.5 years were 

examined.  No evidence of baritosis was observed in any of the workers.  In 1961, eight workers 

(26-45 years of age, mean of 32) employed for 3.5-18 years (mean of 9) were examined (one of 

these workers was also examined in 1947).  Seven of the workers reported no respiratory 

symptoms; one worker reported a slight occasional cough.  No abnormal symptoms were noted 

during the physical examination of seven of the workers; crepitations dispelled by cough were 

observed in one worker (not the same worker reporting an occasional cough).  Pneumoconiosis 

was detected in the radiographs of seven workers.  Three other workers employed for 1 month to 

1 year were also examined in 1961.  Two of these workers reported having slight coughs, but no 

abnormal findings were observed during the physical examination and the chest radiographs 

were normal.  At this time, dust concentrations, ranging from 2734 to 11,365 particles per mL, 

12

---