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Author Topic: Lead toxicity
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Posts: 165
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Post Lead toxicity
on: April 29, 2013, 15:53
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I have a guy who had multiple gunshot wounds --> 4 bullets; more than 10 yrs ago. A CXR that was found years later, showed multiple bullet fragments. Since then he's had problems with elevated lead levels up to as high as 56 ug/dl at one point, last one I saw was 28 last year. As a result he has CKD from chronic lead exposure thought to be from the bullet fragments that’s still in him.

I don't see that he received any treatments. Other complications he's had have been hypertension but now not on any meds, depression, anxiety and memory problems. I'm going to repeat labs since it has been one year since he's had any but wanted to see if you guys have any experience with chelation therapy and I'm not sure if it's even indicated at this point since his levels are not very high. Obviously, we won't be able to remove the source of lead as he has small bullet fragments. Thanks.

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Post Re: Lead toxicity
on: April 29, 2013, 16:05
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Wow! I saw plumbism once in a patient who was shot 3 months prior to diagnosis. He had bullet fragments in his synovium, which leeches out more lead than in other areas.

His peak lead level was 196 and he had anemia and lethargy. We treated him with succimer and brought his levels down to 60 with symptomatic improvement. However we could not keep him on therapy indefinitely and thus the bullet fragments were removed.

In your patient's case, I'm not sure if chronic chelation therapy is wise. If the fragments could be removed then chelation for a short time would be useful. If you can't get the fragments out, however, I'm not sure how long you'd treat with chelation.

Also, succimer works by increasing urinary lead excretion. However, if your patient already has CKD, I'm not sure how much urinary excretion you would get.

http://www.ncbi.nlm.nih.gov/m/pubmed/1663439/

Tejas
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Posts: 34
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Post Re: Lead toxicity
on: May 1, 2013, 14:10
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I read [the] response [above] and without doing a lit search, I don’t have additional suggestions beyond what he said. This is an interesting case. [My chief] used to have me check lead levels on patients when I was a fellow, usually related to patient’s providing a history of moonshine intake made in lead containing devices.

I have never seen a case of lead toxicity, though admittedly haven’t looked as much as I did early on. Have also never used chelation therapy, but would want to be aware of pros and cons before using it. I agree it would only be a bridge to removal of the fragments, which doesn’t sound practical from your [post].

Hopefully your repeat lead level will be stable or lower.

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