Barium is a radio-opaque contrast agent that is used for diagnostic purposes. It is used as a diagnostic aid for computed tomography or for gastrointestinal radiographs.

Most of the topic focuses on contraindications, warnings, and precautions.

Barium sulphate Dose in Pregnancy & Lactation:

• It is not systemically absorbed, therefore, no adverse fetal outcomes are expected.
• Radiation exposure is generally avoided in pregnancy.

Barium use during breastfeeding:

• It may be safely used during breastfeeding as systemic absorption does not occur 

Contraindications to Barium include:

• Barium and any other ingredient in the formulation-related allergic responses
• Gastrointestinal obstruction
• Diagnosed or suspected gastric or intestinal perforation
• Patients at high risk for gastrointestinal perforation
  • Patients who have had a history of gastrointestinal perforation in the past
  • Ischemia or acute gastrointestinal hemorrhage
  • Severe ileus
  • Toxic megacolon
  • After gastrointestinal surgery, or biopsy
  • Recent radiotherapy to the pelvis.
  • Acute burns and gastrointestinal injuries
• Patients at high risk for aspiration
  • Patients who have a history of
  • aspiration
  • Tracheoesophageal fistula
  • Obtundation

Rectal formulations are contraindicated

• Megacolon suspected or diagnosed as toxic
• Recent rectal surgery
• Radiotherapy for the prostate or rectum
• You should use it within six days after a large forceps colonic biopsectomy or a snare biopsy.

Warnings and Precautions

• Aspiration:
  • Aspiration pneumonitis can occur in patients who have difficulty swallowing or who have a history of food aspiration.
  • If you are at high risk for aspiration pneumonitis, it should be used cautiously.
  • Stop immediately if you suspect aspiration and keep the patient hydrated.
• Hypersensitivity
  • Hypotension, wheezing and bronchospasm can all be signs of severe allergic reactions.
  • Itching, urticaria and rash may all be symptoms of mild allergic reactions.
  • For serious systemic reactions, emergency management facilities should always be on hand. Patients should be closely monitored for around an hour.
  • Atopic asthma and patients with a history if food allergies are particularly at risk.
• Leakage intra-abdominal:
  • Leakage of barium may occur in patients at high risk for gastrointestinal perforation. Barium leakage can be caused by the following conditions:
    • Carcinoma
    • Gastrointestinal fistula
    • Inflammatory bowel disease
    • Duodenal or gastric ulcer
    • Diverticulitis
    • Appendicitis is a condition that affects the intestines.
    • Grave gastrointestinal stenosis
  • Peritonitis or granulomas may be caused by barium leakage.
• Intravasation:
  • Barium embolus, which is an intravasation of barium into the vein system, is a rare side effect.
  • It could lead to life-threatening complications.
    • Pulmonary embolism
    • DIAC (Disseminated intravascular Complication)
    • Septicemia
    • Hypotension that is severe and persistent.
• Obstruction and Baroliths
  • If barium accumulation is proximal or severe, it may lead to baroliths and inspissated barsium. This can lead to abdominal pain, appendicitis, and bowel obstruction.
  • Baroliths are a serious concern for patients who are:
    • Grave stenosis in the gastrointestinal tract
    • Impaired gastrointestinal motility
    • Electrolyte imbalance
    • Dehydration
    • Constipation
    • Children with Hirschsprung or cystic fibrosis in their children
    • Patients with dementia
  • Patients must ensure that they are adequately hydrated. Laxatives may be considered in patients at risk of impaction.
• Cardiovascular disease
  • Patients with advanced heart disease and marked hypertension should be cautious.

Monitoring Parameters:

Monitor Renal functions before and after administration.

How to take barium?

Refer to individual product labeling.

Mechanism of action of Barium sulphate:

• It is insoluble and opaque to xrays. It provides radiographic studies with a positive contrast.

It isn'tabsorbedIt is notMetabolizedIt is. It isexcretedIn the feces.

International Brands of Barium sulphate:

• E-Z-Cat Dry
• E-Z-Paste
• Entero VU
• Micropaque
• E-Z-Dose
• E-Z-HD
• Liquid E-Z-Paque
• Liquid Polibar Plus
• Polibar ACB
• E-Z-Disk
• E-Z-Paque
• Varibar Honey
• Varibar Nectar
• Readi-Cat 2
• Tagitol V
• Varibar Pudding
• Varibar Thin Honey
• Sulfuricum
• ColomforT Oral
• Varibar Thin Liquid
• VoLumen Barium
• Falibaryt
• Microtrast
• Prontobario

Barium sulphate Brands in Pakistan: