Slashdot Mirror
Worldwide Shortage of Barium
New submitter redhat_redneck writes "The U.S. and Canada has been experiencing a shortage of barium sulfate, which is used as contrast for upper and lower GI studies. It has reached the point where doctors are being asked not to order these exams except in emergencies, and some exams are being cancelled. Here's the letter that's been put out by the manufacturer. The longer this drags on, the more serious this issue becomes, eventually impacting patients and healthcare providers in both cost and quality of care. Some sources point to a dramatic drop in Chinese production. In their defense, it seems China is changing safety regulations. Medical use only make a fraction of the uses of barium sulfate, but it's going to be disproportionately affected by this shortage. We can't go back to our old contrast Thorotrast; it causes cancer. Does anyone know of alternatives to barium?"
1. Use Thorotrast.
2. People get cancer and die.
3. Then you Barium...
The icky-factor aside, Barium is an element does not vanish and can certainly be sterilized to any degree desired. So, why do they apparently not recycle the stuff?
Most ACs are not even worth the keystrokes to insult them. Be generically insulted by this and ignored otherwise.
Of course Slashdot readers are supposed to get it.
Contrast is what it says. It's there to make whatever you want investigate stand out from the rest observe it. For instance to make blood vessels easier to see. (Now I don't know whatever this is x-ray, MR, ultra-sound or whatever.) My english isn't good enough to know what GI is (gut-ingestion?) but I guess it's the stuff from the throat to the ass.
what GI is (gut-ingestion?) but I guess it's the stuff from the throat to the ass.
Gastrointestinal, your guess is correct: mouth-esophagus-stomach-intestines-anus. It's basically one continuous external surface inside the body.
Barium Sulfate is also HUGELY important in oil well drilling mud.
http://en.wikipedia.org/wiki/Drilling_fluid#Composition_of_drilling_mud
China putting a crimp on drilling mud could have some interesting effects, I'm sure. What makes little sense is the complaining about a shortage in hospitals, where a dose is less then an ounce, when oil drillers are pumping the stuff into the ground by the ton...daily...all over the world. Unless of course somebody wants us to get excited about China stepping on the hose without us finding out where the real shortage is.
I wonder who that might be. I also wonder who submitted this story.
Gastro-Intestinal aka the bit between the mouth and the anus. This stuff shows up (contrasts) on x-rays. Upper studies involve drinking it. Lower studies involve insertion from the other end. In other words, it's used for testing gut disorders and if you aren't swallowing it, you can shove it up your arse.
Barium is a rare earth metal.
Not exactly, Barium is an alkaline earth metal, related to Magnesium and Calcium. Interestingly though, the U.S. are one of the largest producers of Barium, accounting for about 8% of the world wide barium output. It's mainly mined as barit, or heavy spar.
Doesn't anyone recycle this crap?
Layman's explanation: Contrast agent is something that shows up as a bright color on your scan. There are many different kinds of contrast used for many different purposes, too many to list here. Barium contrast is swallowed and shows up as bright white on regular X-rays and CT scans (CTs are a multitude of X-rays taken by a computerized scanner which is then turned into a quasi-3D representation.) The reason somebody would use barium is to look at the shape of the esophagus (food pipe), stomach, intestines, and rectum to see if there are any parts that are too wide, too narrow/pinched off, the wrong shape, if there is a blockage, etc.
Not so layman's explanation of the tests mentioned:
- Barium swallow: Barium is swallowed and a real-time series of X-rays (fluoroscopy) of the throat (pharynx) is done to see if the barium is swallowed properly. The resulting video shows where the barium goes. This is ordered if the doctor suspects the person may be having problems swallowing (aspiration or refluxing.)
- Esophogram: Barium is swallowed and fluoroscopy of the esophagus is performed to see if there are any abnormalities of the size/shape/anatomy of the esophagus. This is also ordered if somebody has trouble swallowing and the doctor suspects some problem like a stricture, widening of the esophagus (achalasia), abnormal anatomy of the esophagus (such as a diverticulum, malignancy, etc.)
- UGI = Upper gastrointestinal study. This fluoroscopy stufy follows the barium from being swallowed until it goes into the stomach. It shows all of the same things as the esophagram along with the size/shape/anatomy of the stomach as well. Ordered for the same reasons as the esophagram as well as if you suspect some anatomic problem with the stomach (e.g. stomach stapling/bypass not working correctly, etc.)
- Small bowel follow through: Barium is swallowed and then a series of individual X-rays taken at certain time intervals to track the progress of the barium through the stomach and small intestine. This is done to investigate things like the stomach emptying too slowly and obstructions in the small intestine.
- Barium enema: Barium is given via enema into the rectum to look at the anatomy of the rectum. This can investigate anatomic abnormalities of the rectum such as masses and fistulas (a hole from the rectum to somewhere else, this is abnormal.) This can also be used to both diagnose and treat intusussception (a disease of infants where part of the large intestine telescopes into itself.)
Just "gittin-r-done," day after day.
Gastrografin is already being used as a viable alternative to barium in radiological studies as contrast for imaging the Gastro-Intestinal (GI) tract, especially in patients where bowel perforation may be imminent (barium spills into the abdominal cavity as a result, causing barium peritonitis; while rare, it is an incredibly deadly complication), in conditions such as intestinal obstruction, for example. See: http://en.wikipedia.org/wiki/Diatrizoic_acid Given that I am but a medical student, this is fairly well known in the medical world. Which makes this an odd question to ask...
Was being brief and assumed the implications were obvious...... guess not
1. Just because a few geeks are certain re-use is ok and might be willing to do it, the general public would not be
2. Even if you are a geek, there's no guarantee some minimum-wage flunky at a re-processing company (or some unionized hospital worker who is mad and in the middle of some "labor action") is gonna do a perfect job and the stuff YOU end up drinking will be properly re-processed. A bit like drinking re-cycled urine .... fine if you are a geek and the processing is being done by the rocket scientists at NASA for the space station, but are you still willing if it's being done by the guy who's only other career option included saying "want fries with that?"
3. A good lawyer will easily convince a typical jury (possibly with members who are anti-science lefties who reject nuclear stuff) that there was some bad thing in the re-processing process (probably done by evil "big hospital" or "big pharma") i.e. it's just another level of "doubt" ....
Think some more and you can imagine many other reasons that each just make the business case a little bit harder to close. No single cut might kill the patient (in this case: re-use of Barium), but lots of little cuts and he bleeds-out
You assume, naively, that the hospital does the recycling and just makes up fresh suspensions. Of course, if any recycling was done it would be to recover the pure BaSO4, which would be the domain of a chemical supplier; who then supplies the material to a pharma company, who then makes the thing you drink, who sells it to the hospital.
Recovering the material from shit is no different to recovering it from the ore it originally came from in the ground. Medical-purity BaSO4 is likely to be a further cut above the lab-grade stuff you can buy from any number of common chemical suppliers - purifying it is trivial - they do it all the time to make the stuff in the first place. What we're discussing here is the economic viability of recovering it from sewage waste. The source is ultimately unimportant. If it ends up in a drug it has to come from a very specific, well monitored source. There's no chance some "flunky" is going to affect the dose of contrast agent you drink. (Oh, and nice, unnecessary jab at union workers and "lefties" there - given your level of discourse and opinion of union labour I'll try and keep my words to fewer than four syllables so you can follow along).
It seems you live in a world full of conspiracies and hidden enemies in the shadows at every turn trying to get one over on you. You might want to just relax a bit. You can log in too; the government is not tracking your slashdot account.
Quoting from the Wikipedia article for Iodine,
"Iodine sensitivity is rare but has a considerable effect given the extremely widespread use of iodine-based contrast media".
So I would say that using Diatrizoic acid/diatrizoate as a Barium replacement (Hypaque, Gastrografin and Ultravist are the trade names) in cases where there is no flagged Iodine sensitivity in the patient is viable, with Barium being used in those rare cases (if in doubt, do a quick Iodine test, as far as I can recall the results are pretty quick - a drop of iodine on the inside of the wrist or elbow, a small rash will form if the recipient is sensitive, and the rash can be treated with standard rash creams (if the recipient is REALLY sensitive, anaphylactic shock is a possibility if a large amount of Ioidine is applied - you dip the person's arm in it - but if the sensitivity is that bad, it should already be flagged). This also has a positive effect for most people, who are generally short of the daily Iodine intake levels they should have.
Disclaimer, my medical knowledge is limited by the fact that I dated and lived with a med student for 7 years, helping her study and revise for exams. Talk to your doctor if you have concerns about your own potential Iodine sensitivity or Gastro-intestinal issues. Do not come to /. and expect sane medical opinions here...
It's basically one continuous external surface inside the body.
You make us sound like living, breathing Klein Bottles...
Not a Klein bottle... We're basically just a living, breathing donut.
E pluribus unum
The issue with US-mined barite/barium sulfate is that is lacks the high purity required to meet pharmaceutical specifications. US barite tends to be lower grade (having higher impurities) and is more suited as an industrial filler or weighting agent in drilling mud.
The word is torus. We are basically homeomorphic to a torus. So are sheep -- apply a mapping such that the interior and exterior of the torus are exchanged, and the result is called a haggis.
It's more invasive, more expensive, and requires general anesthetic.
No. It can and usually is done under twilight sedation.
I can see that would work; watching the Twilight movies would put anyone to sleep.
Donte Alistair Anderson Roberts - hi son!
Karma: Chameleon
You wouldn't be welcome on such a site, given your attitude to questions - which, after all, are a prerequisite to learning.
First, medicine is a science, thus the expression "most scientific and medical terms" is redundant. Second, no one understands most scientific terms. "Science" refers to the entire body of human knowledge, which not only is far too vast for any one person to know most of, but also grows faster than you can learn it - even if your learning capacity was unlimited, the bandwidth of your senses is simply not enough.
Finally, "nerd" doesn't necessarily refer to someone interested in either science in general or medicine in specific. People who are enthusiastic about programming, or matemathics, or 19th century French poetry could all be called nerds without necessarily knowing what "GI" refers to in a medical context - assuming it actually refers to just one thing and isn't reused anywhere. On the other hand, "LEO" is usually used with sufficient context to conclude that we are talking about some kind of satellite orbit or at the very least a space trajectory.
Perhaps you wouldn't have such issues with jocks if you changed your attitude a little? Because I can certainly see why a jock - or, really, anyone - might not like you.
They don't like you because you're an arrogant twat, just in case you didn't get that already.
Forget magic. Any technology distinguishable from divine power is insufficiently advanced.
Typical impurities in US barium sulfate (Nevada mines) are silica and strontium sulfate. Silica can be somewhat removed via froth flotation using standard commercially known techniques. The Sr is bound up in the Ba-Sr-SO4 lattice and very difficult to remove. Were they not bound together in the crystalline structure you could likely use an alkaline leach with sodium hydroxide (I saw a patent from the 1930s or 1940s that discussed this very approach), but when they are bound together you do not get selective leaching. Also, because they are bound together gravimetric separation (SrSO4 = ~3.8 SG IIRC, BaSO4 = ~4.45 SG) doesn't work.
Sr and Ba are very similar chemically, but to meet the USP requirement of 97.5% min BaSO4 you have to be able to get the purity up (or start with a high purity ore). The USP assay test differentiates between the two because of the difference in solubility as chromates - the Sr chromate is much more soluble but you have to convert everything to chromates to get the Sr to drop out, then you'd have to convert the Ba chromate back to BaSO4 and not leave any chromate in there, as it is very toxic. At that point you are no longer dealing with natural purified barium sulfate but are instead making a precipitated barium sulfate, in which case you could just start with pretty much any barium compound and fully react it with sulfuric acid. The problem here is that any soluble barium left behind is very toxic (for a real life example of what could go wrong see http://en.wikipedia.org/wiki/Celobar_incident).
By the time you do all of the processing above the cost is nowhere near what could be achieved with natural, high-purity barium sulfate ore that undergoes a simple acid leach.