succimer and Wounds--Gunshot

A 38-year-old man with a tibial plateau fracture required treatment for elevated blood lead level (BLL) from retained bullet fragments in the same knee from a gunshot wound 21 years earlier. Oral succimer presurgery and postsurgery decreased the BLL from 58 to 15 μg/dL.. Parenteral chelation has been previously recommended to mitigate an increase in BLLs during surgical intervention to remove bullet fragments. Oral succimer was an effective and well-tolerated alternative to intravenous chelation. Further research is needed to determine the optimal route, timing, and duration of chelation in patients with elevated BLL in need of bulletectomy.

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

Lead poisoning from gunshot wounds is unusual. Awareness of this rare but serious complication can guide the physician in making a prompt diagnosis. We present a case of a 30-year-old male who had a remote history of a gunshot wound in the right knee and presented with right knee pain. Plain film showed intrarticular invasion of the bullet fragments. He was also found to have microcytic anemia with high blood lead levels. Chelation therapy was immediately started, followed with surgical removal of the bullet fragments. Lead intoxication is a rare but fatal complication of gunshot wounds. After a timely diagnosis, chelation therapy should be immediately started.

Topics: Adult; Chelating Agents; Chelation Therapy; Diagnosis, Differential; Humans; Knee Injuries; Lead Poisoning; Male; Succimer; Wounds, Gunshot

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

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

Our objective is to present a case of symptomatic lead toxicity (plumbism) with abdominal colic and hemolytic anemia following a gunshot wound. It is a retrospective case report and the setting is in a teaching hospital in south central Los Angeles. The case report is that of a patient who presented with abdominal pain, generalized weakness, and hypertension following multiple gunshot wounds, 15 years previously. Other causes of abdominal pain and weakness--such as diabetes mellitus, alcohol abuse, pancreatitis, and substance abuse--were ruled out. Interventions included treatment with the newer oral chelating agent, Succimer (2, 3-dimercaptosuccinic acid), and subsequent surgery. The main outcome was the initial reduction in blood lead levels with improvement of symptoms. Because of a recurrent rise in the blood lead levels, the patient was again treated with Succimer and underwent surgery to remove two bullet fragments from the face. We conclude that lead toxicity should be ruled out in patients presenting with abdominal cramps and a history of a gunshot wound. Prompt therapy--including environmental intervention and chelation therapy--is mandatory, and surgical intervention may be necessary.

Topics: Abdominal Pain; Adult; Anemia, Hemolytic; Chelating Agents; Humans; Lead; Lead Poisoning; Male; Succimer; Time Factors; Wounds, Gunshot

Topics: Adult; Chelating Agents; Combined Modality Therapy; Debridement; Humans; Lead Poisoning; Male; Preoperative Care; Radiography; Succimer; Thoracic Injuries; Wounds, Gunshot

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

Lead poisoning is an unusual complication of gunshot wounds that occurs when retained lead bullet fragments are in contact with body fluids capable of solubilizing lead. The epidemic of violence by gunfire may result in increasing numbers of lead poisoning cases from this exposure. The use of oral chelation for toxicity resulting from this mode of exposure has not been previously discussed. Cases of lead poisoning arising from bullet lead in the synovial cavity of the hip, synovial cavity of the chest, and pleural space are reported. A combination of surgical debridement and chelation therapy with oral succimer produced a satisfactory outcome in all three cases. Oral succimer may be a safe and effective chelation agent for treating lead toxicity in adults with high lead levels secondary to gun shot wounds.

Topics: Adult; Humans; Lead Poisoning; Male; Middle Aged; Succimer; Wounds, Gunshot

Symptomatic lead poisoning with severe hemolytic anemia was observed in a patient with retained shot gun pellets. Surgical resection of the retained pellets and the use of a newer chelating agent, Succimer (2,3-dimercaptosuccinic acid) successfully lowered blood lead level. Hemolytic anemia was associated with deficient erythrocyte pyrimidine 5'-nucleotidase, and lowering of the lead level corrected the deficiency, suggesting that the enzyme deficiency is responsible for the hemolysis associated with lead poisoning. This case illustrates that retained lead pellets from shotgun wounds can cause severe lead poisoning.

Topics: Adult; Anemia, Hemolytic; Humans; Lead Poisoning; Male; Radiography; Succimer; Wounds, Gunshot