Barium sulfate (READI-CAT 2)

Generic Name: Barium sulfate

READI-CAT 2 and READI-CAT 2 SMOOTHIE (barium sulfate) are radiographic contrast agents supplied as a suspension (2% w/v) for oral administration. The active ingredient barium sulfate is designated chemically as BaSO4 with a molecular weight of 233.4 g/mol, a density of 4.5 g/cm³, and the following chemical structure:

READI-CAT 2 (barium sulfate) Structural Formula Illustration

READI-CAT 2 products contain excipients including: benzoic acid, citric acid, potassium sorbate, saccharin sodium, simethicone emulsion, sodium benzoate, sodium citrate, sorbitol solution, xanthan gum, and purified water.

READI-CAT 2 products also contain natural and artificial flavorings including: banana, blueberry, orange, vanilla, chocolate, and coffee flavors

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Barium sulfate increases the absorption of x-rays as they pass through the body, thus delineating body structures, in which barium sulfate is localized.

Drilling fluids

About 80% of the world's barium sulfate production, mostly purified mineral, is consumed as a component of oil well drilling fluid. It increases the density of the fluid, increasing the hydrostatic pressure in the well and reducing the chance of a blowout.

Radiocontrast agent

Barium sulfate in suspension is frequently used medically as a radiocontrast agent for X-ray imaging and other diagnostic procedures. It is most often used in imaging of the GI tract during what is colloquially known as a "barium meal". It is administered orally, or by enema, as a suspension of fine particles in a thick milk like solution (often with sweetening and flavoring agents added). Although barium is a heavy metal, and its water-soluble compounds are often highly toxic, the low solubility of barium sulfate protects the patient from absorbing harmful amounts of the metal. Barium sulfate is also readily removed from the body, unlike Thorotrast, which it replaced. Due to the relatively high atomic number (Z = 56) of barium, its compounds absorb X-rays more strongly than compounds derived from lighter nuclei.

Pigment

The majority of synthetic barium sulfate is used as a component of white pigment for paints. In oil paint, barium sulfate is almost transparent, and is used as a filler or to modify consistency. One major manufacturer of artists' oil paint sells "permanent white" that contains a mixture of titanium white pigment (TiO2) and barium sulfate. The combination of barium sulfate and zinc sulfide (ZnS) is the inorganic pigment called lithopone. In photography it is used as a coating for certain photographic papers.

Paper brightener

A thin layer of barium sulfate called baryta is first coated on the base surface of most photographic paper to increase the reflectiveness of the image, with the first such paper introduced in 1884 in Germany. The light-sensitive silver halide emulsion is then coated over the baryta layer. The baryta coating limits the penetration of the emulsion into the fibers of the paper and makes the emulsion more even, resulting in more uniform blacks. (Further coatings may then be present for fixing and protection of the image.) More recently, baryta has been used to brighten papers intended for ink-jet printing.

Plastics filler

Barium sulfate is commonly used as a filler for plastics to increase the density of the polymer in vibrational mass damping applications. In polypropylene and polystyrene plastics, it is used as a filler in proportions up to 70%. It has an effect of increasing acid and alkali resistance and opacity.

Niche uses

Barium sulfate is used in soil testing. Tests for soil pH and other qualities of soil use colored indicators, and small particles (usually clay) from the soil can cloud the test mixture and make it hard to see the color of the indicator. Barium sulfate added to the mixture binds with these particles, making them heavier so they fall to the bottom, leaving a clearer solution.

In colorimetry, barium sulfate is used as a near-perfect diffuser when measuring light sources.

In metal casting, the moulds used are often coated with barium sulfate in order to prevent the molten metal from bonding with the mould.

It is also used in brake linings, anacoustic foams, powder coatings, and root canal filling.

Catalyst support

Barium sulfate is used as a catalyst support when selectively hydrogenating functional groups that are sensitive to overreduction. With a low surface area, the contact time of the substrate with the catalyst is shorter and thus selectivity is achieved. Palladium on barium sulfate is also used as a catalyst in the Rosenmund reduction.

Pyrotechnics

As barium compounds emit a green light when burned, barium salts are often used in green pyrotechnic formulas, but the nitrate and chlorate salts are more common. Barium sulfate is commonly used as a component of "strobe" pyrotechnic compositions.

Copper industry

As barium sulfate has high burning point and is insoluble in water, it is used as a coating material in casting of copper anode plates. The anode plates are cast in copper molds, so to avoid the contact of the liquid copper and the solid copper mold, a solution of barium sulfate in water is used as a coating material on the mold surface. Thus when the liquid copper solidifies in form of an anode plate it can be easily released from its mold.

Radiometric measurements

Barium sulfate is sometimes used (or else PTFE) to coat the interior of integrating spheres due to the high reflectance of the material and near Lambertian characteristics

The following adverse reactions have been identified from spontaneous reporting or clinical studies of barium sulfate administered orally. Because the reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or to establish a causal relationship to drug exposure:

  • Nausea, vomiting, diarrhea and abdominal cramping
  • Serious adverse reactions and fatalities include aspiration pneumonitis, barium sulfate impaction, intestinal perforation with consequent peritonitis and granuloma formation, vasovagal and syncopal episodes

Recommended Dosage

  • Base dosing on individual needs and procedure to be performed.
  • Adult and pediatric patients 12 years and older: 450 mL to 900 mL (9 g to 18 g of barium sulfate)
  • Patients younger than 12 years of age: adjust dose based on relative GI volume
Due to its high atomic number, barium (the active ingredient in READI-CAT 2 products) is opaque to x-rays and therefore acts as a positive contrast agent for radiographic studies.

Hypersensitivity Reactions

Barium sulfate preparations contain a number of excipients, including natural and artificial flavors and may induce serious hypersensitivity reactions. The manifestations include hypotension, bronchospasm and other respiratory impairments, dermal reactions including rashes, urticaria, and itching. A history of bronchial asthma, atopy, or a previous reaction to a contrast agent may increase the risk for hypersensitivity reactions. Emergency equipment and trained personnel should be immediately available for treatment of a hypersensitivity reaction.

Intra-abdominal Barium Leakage

The use of READI-CAT 2 products is contraindicated in patients at high risk of perforation of the GI tract. Administration of READI-CAT 2 products may result in leakage of barium from the GI tract in the presence of conditions such as carcinomas, GI fistula, inflammatory bowel disease, gastric or duodenal ulcer, appendicitis, or diverticulitis, and in patients with a severe stenosis at any level of the GI tract, especially if it is distal to the stomach. The barium leakage has been associated with peritonitis and granuloma formation.

Delayed Gastrointestinal Transit And Obstruction

Orally administered barium sulfate may accumulate proximal to a constricting lesion of the colon, causing obstruction or impaction with development of baroliths (inspissated barium associated with feces) and may lead to abdominal pain, appendicitis, bowel obstruction, or rarely perforation. Patients with the following conditions are at higher risk for developing obstruction or baroliths: severe stenosis at any level of the GI tract, impaired GI motility, electrolyte imbalance, dehydration, on a low residue diet, taking medications that delay GI motility, and constipation, pediatric patients with cystic fibrosis or Hirschsprung disease, and the elderly [see Use in Specific Populations]. To reduce the risk of delayed GI transit and obstruction, patients should maintain adequate hydration following a barium sulfate procedure.

Aspiration Pneumonitis

The use of READI-CAT 2 products is contraindicated in patients at high risk of aspiration. Oral administration of barium is associated with aspiration pneumonitis, especially in patients with a history of food aspiration or with compromised swallowing mechanism. Vomiting following oral administration of barium sulfate may lead to aspiration pneumonitis. In patients at risk for aspiration, begin the procedure with a small ingested volume of READI-CAT 2 products. Discontinue administration of READI-CAT 2 products immediately if aspiration is suspected.

Systemic Embolization

Barium sulfate products may occasionally intravasate into the venous drainage of the large bowel and enter the circulation as a “barium embolus” leading to potentially fatal complications which include systemic and pulmonary embolism, disseminated intravascular coagulation, septicemia and prolonged severe hypotension. Although this complication is exceedingly uncommon after oral administration of barium sulfate suspension, monitor patients for potential intravasation when administering barium sulfate.

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