Adverse reactions, such as nausea, vomiting, diarrhea and abdominal cramping, accompanying the use of
barium sulfate formulations are infrequent and usually mild. Severe reactions (approximately 1 in
1,000,000) and fatalities (approximately 1 in 10,000,000) have occurred. Procedural complications are
rare, but may include aspiration pneumonitis, barium sulfate impaction, granuloma formation,
intravasation, embolization and peritonitis following intestinal perforation, vasovagal and syncopal
episodes, and fatalities. It is of the utmost importance to be completely prepared to treat any such
Due to the increased likelihood of allergic reactions in atopic patients, it is important that a complete
history of known and suspected allergies as well as allergic-like symptoms, e.g., rhinitis, bronchial
asthma, eczema and urticaria, must be obtained prior to any medical procedure utilizing these products.
A mild allergic reaction would most likely include generalized pruritus, erythema or urticaria
(approximately 1 in 250,000). Such reactions will generally respond to an antihistamine such as 50 mg
of diphenhydramine or its equivalent. In the rarer, more serious reactions (approximately 1 in
1,000,000) laryngeal edema, bronchospasm or hypotension could develop. Severe reactions which may
require emergency measures are often characterized by peripheral vasodilation, hypotension, reflex
tachycardia, dyspnea, agitation, confusion and cyanosis progressing to unconsciousness. Treatment
should be initiated immediately with 0.3 to 0.5 mL of 1:1000 epinephrine subcutaneously. If
bronchospasm predominates, 0.25 to 0.50 grams of intravenous aminophylline should be given slowly.
Appropriate vasopressors might be required. Adrenocorticosteroids, even if given intravenously, exert
no significant effect on the acute allergic reactions for a few hours. The administration of these agents
should not be regarded as emergency measures for the treatment of allergic reactions.
Apprehensive patients may develop weakness, pallor, tinnitus, diaphoresis and bradycardia following
the administration of any diagnostic agent. Such reactions are usually non-allergic in nature and are best
treated by having the patient lie flat for an additional 10 to 30 minutes under observation.
The presence of barium sulfate formulations in the GI tract may alter the absorption of therapeutic
agents taken concomitantly. In order to minimize any potential change in absorption, the separate
administration of barium sulfate from that of other agents should be considered.