Acute Exposure

Nausea, vomiting, diarrhea and abdominal cramping may occur ^{FDA label}. Acute exposure to barium sulfate may irritate the eyes and respiratory tract. Exposure to inhalation or other forms can affect the nervous system and lead to hypokalemia, which can contribute to cardiovascular rhythm abnormality ^L1957. Hypersensitivity, gastrointestinal transit delay, obstruction, aspiration pneumonitis and systemic embolization of barium sulfate are more serious complications of administration ^{FDA label}. In addition, fatalities have occurred due to aspiration pneumonitis, barium sulfate impaction, intestinal perforation with subsequent peritonitis and granuloma formation, and vasovagal and syncopal episodes ^{FDA label}, ^A32329.

Chronic Exposure

The lungs may be affected by repeated or prolonged exposure to dust particles, resulting in baritosis (a type of benign pneumoconiosis) ^L1957. Inhalation of barium sulfate dust may lead to a benign pneumoconiosis ("baritosis") with conspicuous radiographic characteristics but no signs of impairment of pulmonary function ^L1957.

Intra-abdominal leakage

Intra-abdominal leakage may occur during or after administration of barium sulfate [FDA label}. Caution is advised in several patient conditions such as fistulas, ulcer, inflammatory bowel disease, appendicitis/diverticulitis, severe stenosis or obstruction of the GI tract. Patients should maintain adequate hydration for several days following a barium sulfate procedure to prevent obstruction or impaction caused by batholiths (barium sulfate stones) ^L1959. Caution is advised in patients with a history of food aspiration and in patients with diagnosed swallowing disorders ^{FDA label}.

A note on GI perforation

Perforation of the colon after rectal administration of barium sulfate suspension has been reported due to the increased hydrostatic pressure of the instilled suspension, trauma to the colon from an enema tip, or forceful or deep insertion of a non-flexible enema tip. Perforation of the bowel has been followed by peritonitis, adhesions, granulomas, and death ^L1958. This is a rare occurrence. Injury to the rectal mucosa or anal canal due to the enema tip or retention balloon is likely the most common traumatic cause of perforation during treatment. Inflation of a balloon within a stricture, neoplasm, inflamed rectum, or stoma is hazardous, and caution should be exerted ^A32328.

Carcinogenicity and mutagenicity

No animal studies have been performed to evaluate the carcinogenicity of barium sulfate or potential effects on reproduction ^{FDA label}. Elective contrast radiography of the abdomen is not routintely recommended during pregnancy because of the risks to the fetus from radiation exposure ^L1958.