Change in Blood Lead Concentration up to 1 Year after a Gunshot Wound with a Retained Bullet

Abstract

The authors studied the time course and prevalence of elevated blood lead concentrations and associated injury- and patient-specific factors during the first year following gunshot injury. They determined blood lead levels at mean time points of 0.3, 3.1, 18.7, 94.5, 188.3, and 349.4 days after injury in a volunteer sample of 451 subjects from a Los Angeles, California, trauma center who sustained a first-time gunshot injury with a retained projectile in 2000-2002. In mixed-model analyses, blood lead levels increased with time postinjury (p < 0.0005) up to 3 months, with number of retained fragments (p < 0.0005), and with increasing age (p < 0.0005). Increased blood lead concentration as a function of fragmentation was approximately 30% higher among subjects who had suffered bone fracture in the torso (p < 0.0005). Subjects with bullets or fragments lodged near bone (p < 0.0005) or near joints (p = 0.032) had higher blood lead levels. Logistic models correctly predicted a blood lead elevation of >/=20 micro g/dl in 81% and 85% of subjects at 3 and 6 months postinjury, respectively. The prevalence of elevated blood lead was 11.8% at 3 months and 2.6% at 12 months. The authors recommend continued surveillance of blood lead levels after gunshot injury for patients with key indicators.

Intraorbital Foreign Bodies: Clinical Features and Outcomes of Surgical Removal

“…[11] However, recent, well-designed studies have reported elevated blood lead levels in patients with retained lead pellets compared to matched controls. [12][13][14][15] Bullet fragmentation, multiple bullets, bone fracture, lodgment of bullet near bone or joint, and increased patient age are significant factors associated with high lead levels. [15] Most symptoms of lead toxicity (plumbism) are nonspecific, and diagnosis is missed or delayed in many instances.…”

“…[12][13][14][15] Bullet fragmentation, multiple bullets, bone fracture, lodgment of bullet near bone or joint, and increased patient age are significant factors associated with high lead levels. [15] Most symptoms of lead toxicity (plumbism) are nonspecific, and diagnosis is missed or delayed in many instances. [1,[16][17][18] Patients with retained lead pellets should be considered at risk for lead poisoning and follow-up should continue on regular basis.…”

¿Es el plomo empleado en deportes (caza, tiro y pesca deportiva) un problema de salud pública infravalorado?

“…Sin embargo, la munición 32 de o basada en el Pb aporta un riesgo suplementario: el de intoxicación por el metal pesado, con efectos que pueden llegar a ser incluso letales 33 . Las referencias al tema no son muy abundantes, a pesar de los cerca de 80.000 heridos sin consecuencias fatales que se producen sólo los EEUU.…”

Anestesia em paciente com saturnismo: relato de caso

“…Despite the high incidence of firearm-related accidents, McQuirter et al 2 estimated that less than 100 cases of lead toxicity caused by projectile lodged in the body have been reported in the literature until 2004 2 . Symptom onset is insidious, and high degree of suspicion is required for diagnosis.…”

“…Occupational exposure occurs in foundries, printing, production and recycling of batteries, ceramics, paints, crystals, and with the use of lead-based solders. Use of medications, ingestion of contaminated food or water, and the presence of a firearm projectile lodged in the bones, joints, or tissues are causes of occupational exposure [2][3][4] . Children are more susceptible to the toxic effects of lead for having the blood brain barrier and musculoskeletal system still under development; therefore, they present symptoms at lower concentrations (< 40 µg.dL -1 ) than those found in symptomatic adults (40-60 µg.dL -1 ) 5 .…”