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Severe lead toxicity attributed to bullet fragments retained in soft tissue.

Abstract A man aged 30 years presented to an emergency department with a 1 month history of severe abdominal pain, jaundice, constipation, lower extremity weakness and weight loss. A peripheral blood smear was performed that showed basophilic stippling of erythrocytes prompting a blood lead level (BLL) evaluation. The patient had a BLL of >200 µg/dL. Retained bullet fragments were identified in the left lower extremity from a previous gunshot wound 10 years prior. Lead from the excised bullet fragment was consistent with the patient's blood lead by isotope ratio analysis. This case is a rare example of a severely elevated BLL attributed to bullet fragments in soft tissue. Bullets retained in soft tissue are not often considered a risk factor for a markedly elevated BLL because they become encapsulated within the tissue over time.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title bmj case reports
Publication Year Start




PMID- 28275014
OWN - NLM
STAT- MEDLINE
DA  - 20170309
DCOM- 20170316
LR  - 20170316
IS  - 1757-790X (Electronic)
IS  - 1757-790X (Linking)
VI  - 2017
DP  - 2017 Mar 08
TI  - Severe lead toxicity attributed to bullet fragments retained in soft tissue.
LID - bcr2016217351 [pii]
LID - 10.1136/bcr-2016-217351 [doi]
AB  - A man aged 30 years presented to an emergency department with a 1 month history
      of severe abdominal pain, jaundice, constipation, lower extremity weakness and
      weight loss. A peripheral blood smear was performed that showed basophilic
      stippling of erythrocytes prompting a blood lead level (BLL) evaluation. The
      patient had a BLL of >200 microg/dL. Retained bullet fragments were identified in
      the left lower extremity from a previous gunshot wound 10 years prior. Lead from 
      the excised bullet fragment was consistent with the patient's blood lead by
      isotope ratio analysis. This case is a rare example of a severely elevated BLL
      attributed to bullet fragments in soft tissue. Bullets retained in soft tissue
      are not often considered a risk factor for a markedly elevated BLL because they
      become encapsulated within the tissue over time.
CI  - 2017 BMJ Publishing Group Ltd.
FAU - Weiss, Debora
AU  - Weiss D
AD  - Centers for Disease Control and Prevention, Center for Surveillance, Epidemiology
      and Laboratory Services (CSELS), Atlanta, Georgia, USA.
AD  - Wisconsin Department of Health Services, Bureau of Environmental and Occupational
      Health, Madison, Wisconsin, USA.
FAU - Lee, Don
AU  - Lee D
AD  - Ascension Columbia St. Mary's, Milwaukee, Wisconsin, USA.
FAU - Feldman, Ryan
AU  - Feldman R
AD  - Wisconsin Poison Center, Childrens Hospital of Wisconsin, Froedert & the Medical 
      College of Wisconsin, Milwaukee, Wisconsin, USA.
FAU - Smith, Kate E
AU  - Smith KE
AD  - University of Wisconsin-Madison, Wisconsin State Laboratory of Hygiene, Trace
      Element Research Laboratory, Madison, Wisconsin, USA.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20170308
PL  - England
TA  - BMJ Case Rep
JT  - BMJ case reports
JID - 101526291
SB  - IM
MH  - Adult
MH  - Disease Management
MH  - Foreign Bodies/complications/*diagnostic imaging
MH  - Humans
MH  - Lead Poisoning/*blood/etiology
MH  - Male
MH  - Wounds, Gunshot/*complications
EDAT- 2017/03/10 06:00
MHDA- 2017/03/17 06:00
CRDT- 2017/03/10 06:00
AID - bcr-2016-217351 [pii]
AID - 10.1136/bcr-2016-217351 [doi]
PST - epublish
SO  - BMJ Case Rep. 2017 Mar 8;2017. pii: bcr2016217351. doi: 10.1136/bcr-2016-217351.

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