The effects of retained lead bullets on body lead burden

Background: Numerous case reports have demonstrated that lead poisoning wit h potentially fatal consequences can result from retained lead projectiles after firearm injuries, To assess the impact of retained projectiles on sub sequent lead exposure in the population, one cannot rely on self-selected c ases presenting with symptoms of lead intoxication. This preliminary study seeks to identify increased lead burden and identify risk factors of elevat ed blood lead levels for individuals with retained lead bullets. Methods: Forty-eight patients were originally recruited from gunshot victim s presenting for care at the King/Drew Medical Center in Los Angeles, Calif ornia. An initial blood level was measured for all recruited patients and r epeated for the 28 participants available for follow-up, 1 week to 8 months later. Medical history, including a history of prior firearm injuries and other retained projectiles, was taken, along with a screening and risk fact or questionnaire to determine other sources of lead (occupational/recreatio nal) to which the patient might have been, or is at present, exposed, The p articipants also had K-shell x-ray fluorescence determinations of bone lead in the tibia and calcaneus in order to determine past lead exposures not r evealed by medical history and risk factor questionnaire. Multivariate mode ls of blood level were made using risk factor and bone lead concentration d ata. Results: We demonstrated that blood lead tends to increase with time after injury in patients with projectile retention, and that the increase in sign ificant part depended on the presence of a bone fracture caused by the guns hot, Conclusion: We encountered evidence suggesting that the amount of blood lea d increase in time after injury is also dependent on the tibia lead concent ration, There were too few cases in the study to fully test the effects of bullet location, or the interaction of bullet location with bone fracture o r bullet fragmentation.