Severe Lead Toxicity Attributed to Bullet Fragments Retained in Soft Tissue

Details

• Personal Author:
  Feldman R ; Lee D ; Smith KE ; Weiss D
• Description:
  A man aged 30 years presented to an emergency department with a 1 month history of severe abdominal pain, jaundice, constipation, lower extremity weakness and weight loss. A peripheral blood smear was performed that showed basophilic stippling of erythrocytes prompting a blood lead level (BLL) evaluation. The patient had a BLL of >200 µg/dL. Retained bullet fragments were identified in the left lower extremity from a previous gunshot wound 10 years prior. Lead from the excised bullet fragment was consistent with the patient's blood lead by isotope ratio analysis. This case is a rare example of a severely elevated BLL attributed to bullet fragments in soft tissue. Bullets retained in soft tissue are not often considered a risk factor for a markedly elevated BLL because they become encapsulated within the tissue over time. [Description provided by NIOSH]
• Subjects:
  Blood Delivery Of Health Care Hematologic Tests Lead Occupational Health Safety
• Keywords:
  Blood Lead Levels Blood Samples Firearms Gunshot Wounds Medical Care
• ISSN:
  1757-790X
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Journal Article
• Place as Subject:
  Georgia ; OSHA Region 4 ; OSHA Region 5 ; Wisconsin
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  2017
• NIOSHTIC Number:
  nn:20066582
• Citation:
  BMJ Case Rep 2017 Mar; 2017:bcr2016217351
• Contact Point Address:
  Debora Weiss, Centers for Disease Control and Prevention, Center for Surveillance, Epidemiology and Laboratory Services (CSELS), Atlanta, GA
• Email:
  woy2@cdc.gov
• CAS Registry Number:
  Lead (CAS RN 7439-92-1)
• Federal Fiscal Year:
  2017
• Performing Organization:
  Wisconsin Department of Health Services, Madison
• Peer Reviewed:
  True
• Start Date:
  20150701
• Source Full Name:
  BMJ Case Reports
• End Date:
  20260630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:af90ea55ea6d1dc884357e861bea7919c009a45972768af71829f9d148caf1752599862a5404e1735e06654ffb64818e6d5a024ffe5a84a17d57db8fbbc72bd0
• Download URL:
  https://stacks.cdc.gov/view/cdc/231131/cdc_231131_DS1.pdf
• File Type:
  [PDF - 547.85 KB ]