Barium Toxicity After Exposure to Contaminated Contrast Solution — Goias State, Brazil, 2003

Barium-containing contrast solutions are commonly used in radiologic studies. On May 22, 2003, three patients at radiology clinics in Goias State, Brazil, were hospitalized after ingesting such solutions; two persons died within 24 hours of hospitalization. Exposure occurred during radiologic examination of the upper or lower gastrointestinal tract. An investigation was conducted by municipal and state public health authorities with assistance from the Ministry of Health's National Agency for Sanitary Surveillance (ANVISA) and Brazil's Field Epidemiology Training Program (FETP), known locally as EPISUS. This report summarizes the results of that investigation, which found that 44 persons had suspected barium toxicity, nine of whom died. Eight of the nine deaths were linked to a single lot of brand A contrast solution. A national recall was announced on May 23, and the manufacturing facility was inspected and closed. Clinicians should be alert for signs of barium toxicity in patients in the hours after administration of contrast solutions during radiologic studies.