07-05-11 Why is it not a good idea to swallow 'snake' fireworks?

Question of the Week
July 5, 2011
Why is it not a good idea to swallow “snake” fireworks? 
While the most common morbidities from fireworks are the blast injuries and burns, fireworks also contain many substances that can be quite toxic if ingested. One of the earth metals used for the green color on ignition is barium chlorate. Barium is familiar to health care providers in the barium Sulfate form which is used as an oral contrast agent. Barium Sulfate is insoluble and non-absorbable and therefore nontoxic. The other barium salts such as barium chlorates are quite toxic and many are used as pesticides.
Barium salts other than barium sulfate cause shifting of potassium into the intracellular space and are thought to block potassium efflux. Typical clinical findings after ingestion include severe vomiting and diarrhea due to increased GI motility. Ventricular dysrhythmias occur with QT prolongation due to the profound hypokalemia that occurs. Muscle weakness is common as well. Treatment includes possible oral administration of magnesium sulfate to try and convert some of the barium to barium sulfate, the insoluble form.  Supportive care and ventilator support are needed.  Potassium administration is usually needed when there are cardiovascular manifestations such as ventricular dysrhythmias; however, the potassium levels must be closely monitored as once the barium toxicity resolves, the potassium can shift back out of the intracellular compartment and hyperkalemia may occur with continued exogenous administration. Hemodialysis has been reported to enhance elimination of the barium.
This question  prepared by:  Saralyn Williams, MD   Medical Toxicologist

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