succimer and Foreign-Bodies

Few recommendations exist for management of chronic lead toxicity in instances when the source of lead exposure cannot be removed.. We describe 2 patients who had shotgun wounds resulting in multiple retained lead pellets. They developed elevated blood lead levels and were treated with 2 weeks of high-dose oral succimer before being placed on maintenance oral succimer therapy with the goal of sustaining suppressed lead levels.. Retained lead pellets have been associated with increasing blood lead levels over time. Chronic lead toxicity can cause significant morbidity. Few treatments for lead toxicity are available, and there is scarce data on maintenance therapy for patients who have large numbers of retained shotgun pellets.. This case series documents 2 patients who continue on maintenance oral chelation therapy with succimer in an effort to prevent the sequelae of chronic lead toxicity by maintaining blood lead levels less than 20 μg/dL.

Topics: Adult; Chelating Agents; Female; Foreign Bodies; Humans; Lead; Lead Poisoning; Male; Succimer; Wounds, Gunshot

Topics: Adult; Anemia; Chelating Agents; Diagnosis, Differential; Foreign Bodies; Humans; Lead Poisoning; Male; Nurse Practitioners; Risk Factors; Severity of Illness Index; Shoulder Injuries; Shoulder Pain; Succimer; Wounds, Gunshot

Topics: Cheek; Chelation Therapy; Child, Preschool; Dimercaprol; Drug Therapy, Combination; Edema; Edetic Acid; Environmental Exposure; Foreign Bodies; Humans; Lead; Lead Poisoning; Male; Pica; Play and Playthings; Protoporphyrins; Seizures; Self-Injurious Behavior; Succimer; Wounds, Gunshot

Lead poisoning is rare. Intake of lead shots may cause damage of the bone marrow, the nervous system, the liver, the kidneys and the endocrine organs.. We present two patients who had taken approximately 120 grams of lead shots. They developed asthenia, nausea and abdominal pain. We tried to remove the lead shots with fluids, laxatives and colonoscopy, but ultimately surgical intervention had to be performed. The patients were also treated with dimercaptosuccinic acid (DMSA).. Although DMSA treatment is associated with a significant decrease in blood lead concentration and an increase of lead urinary excretion, surgical intervention is the most efficient way of treating oral intake of lead. Treatment with DMSA will probably have to go on for months in order to give an additional effect.

Topics: Adult; Antidotes; Foreign Bodies; Humans; Lead Poisoning; Male; Middle Aged; Succimer

Topics: Adult; Chelating Agents; Chelation Therapy; Female; Fetal Diseases; Foreign Bodies; Humans; Infant, Newborn; Iron; Lead Poisoning, Nervous System, Adult; Maternal-Fetal Exchange; Pregnancy; Pregnancy Complications; Radiography; Succimer; Time Factors; Wounds, Gunshot

Topics: Chelation Therapy; Colonoscopy; Combined Modality Therapy; Female; Foreign Bodies; Humans; Infant; Intestines; Lead Poisoning; Succimer; Therapeutic Irrigation

A 45-y-o male with a history of schizophrenia was admitted to a local VA psychiatric unit. Five days later, endoscopy due to abdominal pain, gastrointestinal bleeding and blood hemoglobin of 5.6 g/dL revealed bullets in the stomach. On subsequent radiograph, > 50 bullets were visualized in the stomach and intestines. Poison Center recommendations included whole bowel irrigation and a blood lead level. After poor results with gastrointestinal decontamination and a repeat radiograph showing > 100 cartridges, surgical intervention was considered but not performed due to perceived risk of bullet detonation from electrocautery. The blood lead was reported as 391 mcg/dL. Calcium EDTA therapy was initiated, followed by aggressive gastrointestinal decontamination. Four days of whole bowel irrigation facilitated passage of 206 cartridges over the next 10 days. The patient was discharged on a 14-day course of 600 mg Succimer tid to treat the bone lead deposits and blood lead level of 49 mcg/dl. An outpatient visit 6 w later showed the blood lead level had dropped to 24 mcg/dl. Aggressive gastrointestinal decontamination and calcium EDTA and Succimer administration successfully treated an ingestion lead bullets and the resulting lead poisoning.

Topics: Antidotes; Chelating Agents; Colon; Edetic Acid; Foreign Bodies; Gastrointestinal Hemorrhage; Humans; Lead; Lead Poisoning; Male; Middle Aged; Schizophrenia; Succimer; Suicide, Attempted; Therapeutic Irrigation; Treatment Outcome

Ingestion of elemental lead foreign bodies is felt to have a low risk of clinically significant lead absorption unless gastrointestinal pathology and/or prolonged transit time are present. We present a case of ingestion of a large quantity of small diameter lead shot accompanied by rapid elevation of blood lead levels.. A 5 1/2-year-old previously healthy girl was found eating the pellets from an ankle weight. She vomited and complained of abdominal pain. In the emergency department, she had no complaints and normal vital signs. An abdominal X-ray showed thousands of small, round, metallic density objects in the stomach. Her white blood cell count was 14,700/mm3, and the hemoglobin, mean corpuscular volume, free erythrocyte protoporphyrin, zinc protoporphyrin, biochemistry panel 21, and urinalysis were normal. She had no prior lead level for comparison. Whole-bowel irrigation was begun and she passed over 11 stools with pellets as well as other foreign bodies (erasers, bead, etc.) in the first 24 hours. Pellets were still seen on X-ray the following day so she received a high-fiber diet and bisacodyl tablets 10 mg/d. On hospital day 2, her admission blood lead (drawn 13 hours after ingestion) was reported as 57 microg/dL (2.7 microm/L) and chelation was begun with oral 2,3-dimercaptosuccinic acid 10 mg/kg 3x/d for 5 days, then 2x/d for 14 days. Her peak measured lead level was 79 microg/dL approximately 36 hours after ingestion. She excreted 2,273 microg lead in the urine during her first 24 hours of chelation. Her blood lead dropped to 14.3 microg/dL by the end of chelation. She did not develop any apparent signs of lead poisoning.. Acute elevations of blood lead concentrations may occur rapidly after ingestion of multiple small elemental lead objects.

Topics: Antidotes; Bisacodyl; Child, Preschool; Dietary Fiber; Female; Foreign Bodies; Humans; Lead; Lead Poisoning; Radiography; Stomach; Succimer; Therapeutic Irrigation; Treatment Outcome

A 47-year-old man with a prior gunshot wound presented with arthritis, constipation, abdominal pain, and weight loss. Arthrocentesis did not reveal the cause of the arthritic complaints, but lead poisoning was suspected and confirmed. We present this case along with a short review of the literature pertaining to this often overlooked and reversible cause of lead poisoning.

Topics: Chelating Agents; Chelation Therapy; Foreign Bodies; Humans; Lead Poisoning; Male; Middle Aged; Succimer; Wounds, Gunshot

Topics: Adult; Chelating Agents; Female; Foreign Bodies; Humans; Knee Injuries; Knee Joint; Lead Poisoning; Radiography; Succimer; Wounds, Gunshot