History: Patient (pt) came into ER with a blood lead level of over 150 µg/dL. For adults, a blood lead level of 5 µg/dL or more is considered elevated. Pt’s begin to have serious symptoms of lead poisoning when levels are greater than 40 µg/dL, and levels above 80 µg/dL can damage one’s health very rapidly and can be fatal. Before this particular visit to the ER, this pt had been shot with a gun bullet a few years ago in the lower thigh. Many bullets are left inside of pt’s post-trauma because they do not affect pt’s outcomes or ability to recover; trying to remove bullets surgically could result in more damage to certain areas that are already affected. However, when bullets contain lead, they can cause a future onset of lead poisoning. For this particular case, this pt’s bullet migrated from the lower thigh into the knee joint. From there, it began to dissolve within the synovial fluid of the knee joint capsule and elevated blood lead levels throughout their whole system. It is not known for how long this pt has had elevated blood lead levels or if they had previous treatment.

Q: What will be the outcome for this pt? What is the treatment for lead poisoning? Can this pt fully recover from the damage lead poisoning has caused to their body?

A: As stated in a journal article found about the topic, the outcome for this pt truly depends on the severity and the ability to manage the toxic levels. A principle in toxicology is to remove the source – in this case the bullet – but this cannot be done without surgery. Treatment consists of chelation therapy which basically involves the administration of a chelating agent(s) that remove heavy metals from the body. Because of the location that this bullet is in for this pt (inside the knee joint capsule), it is important not to manipulate or cause any more damage to the dissolving bullet. More disruption would further increase blood lead levels. Once blood lead levels decrease with chelation therapy, this pt can later transition into surgery for removal of the bullet if that is needed. Nevertheless, any damage caused by lead poisoning cannot be reversed. It is important to remove the source of lead and ensure blood levels return to normal. This will prevent any further damage in the future, but it will not allow the pt to recover from any damage that has already taken place.

Lead poisoning due to bullets lodged in the human body –> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4001953/