RETAINED LUMBAR BULLET: A CASE REPORT OF CHRONIC LEAD TOXICITY AND REVIEW OF THE LITERATURE

被引:14
作者
Bustamante, Nirma D. [1 ,2 ]
Macias-Konstantopoulos, Wendy L. [2 ,3 ]
机构
[1] Brigham & Womens Hosp, Dept Emergency Med, 75 Francis St, Boston, MA 02115 USA
[2] Massachusetts Gen Hosp, Dept Emergency Med, Boston, MA 02114 USA
[3] Harvard Univ, Sch Med, Dept Emergency Med, Boston, MA USA
关键词
chelation therapy; lead toxicity; plumbism; retained bullet; TISSUE LEAD; MANIFESTATIONS; ARTHROPATHY;
D O I
10.1016/j.jemermed.2016.02.025
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: Lead toxicity from retained bullet fragments is difficult to both predict and diagnose, but important to treat early, given the potential severity of disease. Blood lead levels > 25 mu g/dL and 40 mu g/dL are considered toxic in children and adults, respectively. Symptoms may range from nonspecific constitutional symptoms to seizures and coma. Chelation is the mainstay therapy for lead poisoning and levels to treat depend on patient age, blood lead levels, and the presence of symptoms. Case Report: We present the case of a woman with symptoms of severe lead toxicity from 20-year-old retained bullet fragments. She had been seen by multiple providers for evaluation of each symptom, but a unifying diagnosis had not been found. After identifying this complication, she was treated appropriately and more serious complications were prevented. Why Should an Emergency Physician Be Aware of This?: We present this case to increase awareness among emergency physicians of lead toxicity in patients with a seemingly unrelated constellation of symptoms and a history of a previous gunshot wound with retained bullet or bullet fragments. (C) 2016 Elsevier Inc. All rights reserved.
引用
收藏
页码:45 / 49
页数:5
相关论文
共 38 条
[1]  
Benjelloun M, 2007, SAUDI J KIDNEY DIS T, V18, P83
[2]   Lead poisoning and Burton's line [J].
Camuglia, Jayne E. ;
Grigoriadis, George ;
Gilfillan, Christopher P. .
MEDICAL JOURNAL OF AUSTRALIA, 2008, 189 (06) :339-339
[3]   Get the lead out [J].
Chan, GM ;
Hoffman, RS ;
Nelson, LS .
ANNALS OF EMERGENCY MEDICINE, 2004, 44 (05) :551-552
[4]   Lead toxicity in a 14-year-old female with retained bullet fragments [J].
Coon, T ;
Miller, M ;
Shirazi, F ;
Sullivan, J .
PEDIATRICS, 2006, 117 (01) :227-230
[5]   THE GASTROINTESTINAL MANIFESTATIONS OF GUNSHOT-INDUCED LEAD-POISONING [J].
DASANI, BM ;
KAWANISHI, H .
JOURNAL OF CLINICAL GASTROENTEROLOGY, 1994, 19 (04) :296-299
[6]  
de Madureira P R, 2000, Sao Paulo Med J, V118, P78
[7]  
de Sion B, 1867, UNION MED, V3, P89
[8]  
DILLMAN RO, 1979, AM J MED, V66, P509, DOI 10.1016/0002-9343(79)91083-0
[9]   Lead Toxicity Associated with a Gunshot-Induced Femoral Fracture A Case Report [J].
Dougherty, Paul J. ;
van Holsbeeck, Marnix ;
Mayer, Theodore G. ;
Garcia, A. Joseph ;
Najibi, Soheil .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 2009, 91A (08) :2002-2008
[10]   Blood lead levels in emergency department patients with retained lead bullets and shrapnel [J].
Farrell, SE ;
Vandevander, P ;
Schoffstall, JM ;
Lee, DC .
ACADEMIC EMERGENCY MEDICINE, 1999, 6 (03) :208-212