Journal of Analytical Toxicology 2013;37:222 –226 doi:10.1093/jat/bkt015 Advance Access publication March 6, 2013 Article Application of ICP-OES to the Determination of Barium in Blood and Urine in Clinical and Forensic Analysis Teresa Lech1,2* 1 Institute of Forensic Research, Westerplatte 9, 31-033 Krakow, Poland and 2Department of Toxicology, Faculty of Pharmacy, Collegium Medicum, Jagiellonian University, Medyczna 9, 30-688 Krakow, Poland *Author to whom correspondence should be addressed. Email: [email protected] Exposure to barium (Ba) mostly occurs in the workplace or from drinking water, but it may sometimes be due to accidental or intentional intoxication. This paper presents a reliable, sensitive method for the determination of Ba in blood and urine: inductively coupled plasma optical emission spectrometry (ICP-OES) after microwave digestion of samples. The overall procedure was checked using Seronorm Whole Blood L-2, Trace Elements Urine and spiked blood and urine samples (0.5 –10 mg/mL of Ba). The accuracy of the whole procedure (relative error) was 4% (blood) and 7% (urine); the recovery was 76 –104% (blood) and 85– 101% (urine). The limits of detection and quantification (Ba l 5 455.403 nm) were 0.11 and 0.4 mg/L of Ba, respectively; precision (relative standard deviation) was below 6% at the level of 15 mg/L of Ba for blood. This method was applied to a case of the poisoning of a man who had been exposed at the workplace for over two years to powdered BaCO3, and who suffered from paralysis and heart disorders. The concentrations of Ba, in mg/L, were 160 (blood), 460 (serum) and 1,458 (urine) upon his admission to the hospital, and 6.1 (blood) and 4.9 (urine) after 11 months (reference values: 3.34 + 2.20 mg/L of Ba for blood and 4.43 + 4.60 mg/L of Ba for urine). Introduction Barium (Ba) compounds are widely applied in many fields, such as in the oil and gas industries; in the production of lubricating oil additives (dinonylnaphthalene sulfonate); in making paints (sulfate and chloride), bricks, ceramics, glass (carbonate), rubber, vinyl stabilizers and steel hardening (chloride) (1 –3), fireworks or propellants (carbonate, nitrate and styphnate) (4 –5), rodenticides (carbonate and nitrate) (6 –11) and cosmetics (sulfide) (12). Exposure to this element mostly occurs in the workplace (13 –15) or from drinking water (2 –3, 16). There may also be accidental exposure from other sources (e.g., from contaminated flour) (10) or from intentional intoxication (forensic cases) (7, 11, 12, 14, 17 –20). The health effects of the different barium compounds depend on how well the given compound dissolves in water. Only barium sulfate is considered to be an innocuous, or at worst, a minimally harmful compound (1 –3, 12); however, cases of non-fatal or fatal poisonings after oral administration of barium sulfate for contrast radiography have been described (21 –22). The barium cation is extremely toxic and causes characteristic gastrointestinal symptoms, periorbital and extremity paresthesia, hypertension and progressive flaccid muscular paralysis (1 –3, 12) that can result in death, a condition referred to in the past as Pa Ping (16). Rarely, rhabdomyolysis, respiratory failure and hypophosphatemia may develop (7). Profound hypokalemia can also be induced (1– 3, 12). Concentrations of Ba in blood and urine that affect human health can be rather low. The concentrations of Ba in biological specimens vary broadly from approximately 1 mg/L or less in blood and plasma/serum, below10 mg/L in urine to a few mg/g in bone, hair, nails and teeth (23). Therefore, reliable analytical tools for the clinical and forensic analysis of biological material for barium need to be applied, because some basic methods, such as flame atomic absorption spectrometry (FAAS), are not adequately sensitive [limit of detection (LOD) of approximately 10 mg/L in aqueous solutions, but several times worse for real samples]. To determine the normal concentrations of Ba in body fluids, inductively coupled plasma mass spectrometry (ICP-MS) or electrothermal atomic absorption spectrometry (ET-AAS) can be used, because they offer excellent detection capabilities (LOD of 1.2 ng/L) (1 –2, 13, 17, 23). In cases of chronic or acute poisonings, however, other methods may be applied (1, 23). In ET-AAS, the atomization efficiency of biological samples is rather low due to the formation of numerous side products such as BaC2, BaCN, BaO, Ba(OH)2, BaS, BaCl and BaCl2 (23). In the inductively coupled plasma optical emission spectrometry (ICP-OES) technique, only boric acid or sodium borate were reported to interfere with the line emission spectra of barium at 455.403 nm (2). Neutron activation analysis (NAA) used to be applied to different kinds of samples (hair and bone biopsies with LOD of 0.2 mg/g), but it is no longer used (23). In this paper, a simple, sensitive and reliable method involving moderate costs and fairly rapid analysis time has been proposed for the determination of Ba in biological samples (blood and urine) by ICP-OES after microwave digestion with nitric acid and hydrogen peroxide. The aim of the study was to evaluate whether the ICP-OES method is suitable for the determination of Ba in body fluids (blood, serum and urine) in cases of chronic and acute poisonings, and possibly for the determination of normal (reference) levels of Ba. Experimental Samples Samples of blood, serum and urine were collected (Sarstedt Monovette Li-Heparin LH/2.6 mL tubes for blood, Eppendorf test tubes for serum, 100 mL plastic vessels for urine) from a patient of a hospital in Poland who had been exposed to a barium compound at his workplace (a ceramic factory) for over two years. The patient probably inhaled barium carbonate powder. Samples of blood (n ¼ 24) and urine (n ¼ 25) were obtained from non-exposed people ( patients of a hospital in Krakow, Poland) to validate the procedure and to estimate reference levels. # The Author [2013]. Published by Oxford University Press. All rights reserved. For Permissions, please email: [email protected] Table I. Sample Preparation Material Blood: Seronorm Whole Blood L-2 Serum Urine: Seronorm Trace Elements Urine Volume of sample (mL) Microwave digestion HNO3 H2O2 2 2 0.5 10 5 3 3 3 3 3 1 1 1 1 1 Before determination, samples of investigated material (2 mL of blood, 0.5 mL of serum or 20 mL of urine) were digested by nitric acid (3 mL) and hydrogen peroxide (1 mL) in an Ethos 1 microwave digestion system (Milestone, Italy). Details are given in Table I. Instrumentation The analysis was conducted by using an iCAP 6300 duo plasma emission simultaneous spectrometer (Thermo Electron, Waltham, MA), allowing the recording of the full emission spectrum of the sample in the range from 166.250 to 847.000 nm with the help of a charge-injection device (CID). The fundamental features of the spectrometer and measuring conditions applied in the analysis are presented in Table II. The instrument was calibrated against multi-element standards. Linear regression analysis gave a regression coefficient (R 2) of 0.999 for an emission line of l ¼ 455.403 nm in the concentration range up to 9.0 mg/mL of Ba, and for l ¼ 233.527 and 230.527 nm up to 50.0 mg/mL of Ba (R 2 . 0.999). Reagents All reagents were analytical grade: concentrated nitric(V) acid of special purity (Suprapur) and 30% hydrogen peroxide (Merck, Darmstadt, Germany). The calibrations for Ba and spiked samples were prepared with 1,000 mg/L of ICP multi-element (Ag, Al, B, Ba, Bi, Ca, Cd, Co, Cr, Cu, Fe, Ga, In, K, Li, Mg, Mn, Na, Ni, Pb, Sr, Tl and Zn) standard solution IV (Merck). The accuracy of the method was assessed on the basis of two certified materials: blood (Seronorm Whole Blood L-2) and urine (Seronorm Trace Elements Urine) (SERO AS, Billingstad, Norway). Deionized water obtained from NANOpure Diamond apparatus produced by Barnstead (Dubuque, IA) was used to prepare working standard solutions and to dilute samples. Results The overall procedure was assessed by using standard reference materials (Seronorm Whole Blood L-2 and Seronorm Trace Elements Urine) and different spiked blood and urine samples (in the range of 0.5 –10 mg/mL of Ba). The accuracy of the whole procedure—digestion in a microwave system and determination by ICP-OES—expressed as a relative error was 4% (blood) and 7% (urine) (Table III). The recovery of the method using spiked samples was 76 –104% (blood) and 85 –101% (urine), depending on the dilution of the solution after Final volume (mL) Dilution with water before measurement 10 10 10 20 10 1:10, 1:5 or 1:2 (similar results obtained) 1:10, 1:5 or 1:2 (similar results obtained) 1:10 or 1:5 (similar results); 1:2 (lower results obtained) Table II. Specifications and Working Conditions of the ICP-OES Device Monochromator Echelle type Detector Radio frequency generator power Radio frequency Plasma observation Pump rate Integration time (low/high wavelength) Auxiliary gas flow Coolant gas flow Spray chamber Nebulizer gas pressure CID 1.150 kW 27.12 MHz Radial/axial (auto view) 50 rpm 15 s/15 s 0.5 L/min 20 L/min Cyclonic with concentric nebulizer (Meinhard) 0.14 MPa Table III. Analysis of Certified Materials Sample Certified value (mg/L of Ba) Found (mg/L of Ba) Accuracy* (%) Seronorm Whole Blood L-2 (n ¼ 5) Seronorm Trace Elements Urine (n ¼ 5) 66 + 4 53 + 5 69 + 4 57 + 5 4.0 7.0 *Relative error in percentage. mineralization (matrix dilution can affect the accuracy of the method). The limits of detection (LOD) and quantification (LOQ) measured (n ¼ 20) for the replicates of the blank (taken through the digestion procedure before analysis, diluted 1:10 for measurements), accepted to be three times the standard deviation (SD) for the LOD and 10 times the SD for the LOQ at the most sensitive emission line of Ba (l ¼ 455.403 nm), were 0.11 and 0.4 mg/L of Ba, respectively. The precision [relative standard deviation (RSD)], determined on the basis of results obtained for three different samples of digested blood, each tested 10 times for Ba, was below 6% at the level of 15 mg/L of Ba for blood. The results of the analysis of blood, serum and urine samples in the case of a man suspected to have been poisoned by barium carbonate, probably by inhalation at his workplace, are presented in Table IV. The concentrations of Ba in blood (n ¼ 24) and urine (n ¼ 25) in people not exposed to Ba obtained by the author (the lowest value of the range: LOQ/2) and those found or cited by other analysts are summarized in Table V. Discussion Very little has been published on the analysis of biological samples for Ba by AAS. FAAS lacks sensitivity, although it is Application of ICP-OES to the Determination of Barium in Blood and Urine in Clinical and Forensic Analysis 223 possible to use it only for acute poisonings, and only after extraction, for example by tetrasodium versenate in alkaline solution, with an LOD of 30 mg/L (32). Most ET-AAS applications have been used in the analysis of drinking water within the range of a few mg/L to several hundred mg/L, and in the analysis of the very challenging matrix of seawater (23); however, some authors have described its application to the evaluation of barium concentrations, e.g., in a case of acute poisoning (13). It seems that emission techniques (ICP-OES or ICP-MS) may be current methods of choice for the determination of barium in biological material, not only to evaluate levels in chronic or acute poisonings, but also to estimate reference levels. Although ICP-MS offers excellent detection capabilities in the analysis of bone, erythrocytes, plasma and other biological tissues (23), it is one of the most expensive techniques. Because of this, the proposed method using ICP-OES may be very useful in the routine analysis of clinical and forensic samples for barium, and simultaneously for other elements if necessary. This technique has previously been applied to the multielement (including Ba) analysis, of urine, serum, blood (antemortem samples) and bone or other postmortem samples (2, 27, 33). Some problems, however, concern the pre-treatment of biological samples before determination by different procedures. Most sample decomposition procedures should be applicable, except for those employing sulfuric acid-containing mixtures, due to low solubility and possible co-precipitation of barium sulfate. Currently, preference is given to wet digestion by nitric acid or a nitric acid –hydrogen peroxide mixture in a microwave system, which was used in this study. In the procedure for the ICP-OES analysis of serum, Rahil-Khazen et al. (27) used similar sample digestion (serum: HNO3 –H2O2 in a ratio of 3:2:1). Mauras and Allain (24) merely diluted samples of blood Table IV. Concentrations of Ba in Blood and Urine in a Man Exposed to BaCO*3 Sample Concentrations of Ba (mg/L) Blood Serum Urine On admission to hospital After 11 months 160 460 1,458 6.1 — 4.9 *A dash indicates that the sample was not analyzed. and urine with demineralized water and then analyzed them. The detection limits achieved were 0.06 mg/L of Ba for water, 0.25 mg/L of Ba for urine and 0.6 mg/L of Ba for blood. Schramel et al. (25) analyzed urine samples for Ba, Sr, Ti and other elements (B, Ca, Cu, Fe, Mg, P and Zn) by the ICP-OES technique after acidification of a sample (10 mL of concentrated nitric acid of high quality/100 mL of urine). Physiological reference values reported for Ba, which are of particular interest in the field of occupational medicine due to relatively common exposure at the workplace, are scarce. According to Hamilton et al. (34), the normal values for barium are approximately 4 mg/mL in urine and below 1 mg/mL in blood. Schramel et al. (25) obtained, for 25 samples of urine, mean values of 4.5 + 4.2 mg/mL of Ba, as the reference values for healthy adults. Mauras and Allain (24) obtained a mean value of 4.3 + 1.4 mg/mL of Ba for urine (n ¼ 13). Urinary levels of Ba, determined by ICP-MS in 1,437 samples collected from US patients by Komaromy-Hiller et al. (28), were 3.5 + 2.2 mg/mL of Ba within a range of 1.0 –7.0 mg/mL pf Ba, and they were similar to the reference values from a control population, as reported by Minoia et al. (26). The relevant values obtained in the study using the proposed procedure ranged up to 24 mg/mL for urine (mean: 4.43 + 4.60 mg/mL of Ba; median: 2.20 mg/mL of Ba). Probably due to glass contamination, Rahil-Khazen et al. (27) for serum (n ¼ 141) obtained by using ICP-OES a median value of 60.4 mg/mL of Ba (i.e., 0.44 mmol/mL of Ba in the range of 0.22– 0.71 mmol/mL of Ba); this is similar to the results obtained by Goullé et al. (29) by ICP-MS: median, 111; range, 30– 154 mg/mL of Ba. Limited data have been published on blood barium concentration. Minoia et al. (26) reported levels below 10 mg/mL of Ba; Heitland and Koster (31) obtained by using ICP-MS a median of 0.8 mg/mL of Ba (range: 0.17 –1.9). The barium concentration in the blood of living persons estimated in the present study is within these ranges. Moreover, as established in a previous study (unpublished data), the results obtained for postmortem blood and urine samples of non-poisoned people (n ¼ 63) sent for analysis were usually higher. This may be because of possible contamination during sampling (the samples were collected using different kinds of devices, including those made of glass), and/or putrefaction effects in blood: 41.8 + 32.0 (mean + SD), 36.0 (median), 0.2–168 (range) mg/mL Table V. Concentrations of Ba in Blood and Urine in People Not Exposed to Ba Material Blood Serum Urine Concentrations of Ba (mg/L) Current study (ICP-OES) Maurias and Allain (24) (ICP-OES) Schramel et al. (25) (ICP-OES) Minoia et al. (26) (ET-AAS/ICP-OES) Rahil-Khazen et al. (27) (ICP-OES) Komaromy-Hiller et al. (28) (ICP-MS) 3.34 + 2.20* (0.2 –8.9)† 1.88‡ — ,1 — 1.2 + 0.6* (0.47 –2.9)† — — — — — — 4.3 + 1.4* (1.8 –7)† 4.5 +4.2* (0.2 –12.7)† 2.7 + 1.5* (0.25 –10.1)† 60.4‡ (30.2–97.5)† — 4.43 + 4.60* (0.2 –24)† 2.20‡ *Arithmetic mean + SD. † Range. ‡ Median. 224 Lech 3.5 + 2.2* (1.0 –7.0)† 3.0‡ Goullé et al. (29) (ICP-MS) Heitland and Köster (30–31) (ICP-MS) 0.8* (0.17 –1.9)† 111‡ (30 –154)† 0.89‡ (0.17 –3.85)† — 1.96* (0.1– 14)† of Ba; and urine: 70.6 + 95.1 (mean + SD), 21.3 (median), 0.7 –213 (range) mg/mL of Ba. The concentrations in blood, serum and urine in cases of exposure or acute poisoning with barium compounds are usually considerably higher. In the described case of acute poisoning, probably by inhalation of barium carbonate, levels reached 160 (blood), 460 (serum) and approximately 1,500 (urine) mg/mL of Ba. Inhalative exposure to soluble Ba compounds in a large group of welders resulted in a median urine level up to 101.7 mg/mL of Ba (13). Mauras and Allain (24), in an accidental poisoning, found concentrations of 260 and 280 mg/mL of Ba in blood and urine, respectively. According to Zschiesche et al. (13), only plasma concentrations exceeding 10 mg/L and urine levels higher than 20 mg/L may be assumed to reflect elevated Ba exposure. In cases of the ingestion of Ba compounds, the levels are usually higher. Hung and Chung (14), in a case of poisoning by a mixture of cadmium and barium, reported values in serum of 341 mg/mL of Ba (normal: 30 –200 mg/mL of Ba); Rhyee and Heard (4), in a case of the ingestion of “snake” fireworks, reported 20 –100 mg/mL of Ba in serum and 5,600 mg/mL of Ba in urine. In a fatal case after oral administration of barium sulfate for contrast radiography (due to intravasation), the concentrations in blood reached the following values: 370 mg/mL (39 days after incident) and 150 mg/mL (41 days after incident), and 440 mg/mL in cerebrospinal fluid (39 days after incident) (22). In a suicidal poisoning with barium chloride, autopsy barium levels were: 9,900 mg/mL (blood), 6,300 mg/mL (urine) and 8,800 mg/mL (bile) (17). Conclusions On the basis of this study, it can be concluded that ICP-OES is both reliable and sensitive; thus, it is a current technique of choice for the determination of Ba in body fluids in clinical and forensic toxicology. This study showed LOD and LOQ of 0.11 mg/mL of Ba and 0.4 mg/mL of Ba in solution (l ¼ 455.403 nm), respectively. The accuracy of the whole procedure (as a relative error) was 4% (blood) and 7% (urine), and can be affected by matrix dilution. The recovery of the method for samples digested in a microwave system was 76 –104% (blood) and 85–101% (urine). The concentrations of Ba in biological specimens in nonpoisoned people are low: 3.34 + 2.20 mg/mL of Ba for blood and 4.43 + 4.60 mg/mL of Ba for urine; in poisoning, the levels of Ba are considerably higher. 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