Lead Toxicity Risks in Gunshot Victims

Abstract

BackgroundGunshot wounds require surgeons to decide whether to remove or leave bullet fragments in the body. Surgeons also decide how to follow up with patients who have lead fragments retained in their body. Current literature recommends to remove only intra-articular fragments without the need for a follow-up for patients with the metal retained. Therefore, this study investigates chronic lead toxicity for gunshot wounds.MethodsThe study was performed in the metropolitan area of Rio de Janeiro/Brazil, between 2013 and 2015. It was a case-control study that included 45 victims of gunshot lesions with metallic fragments retained for more than 6 months. The 45 controls were matched for gender, age, and race. We compared the lead blood levels and frequency of symptoms.ResultsThe control group had average blood lead levels of 2.17 μg/dL (95% Confidence Interval [CI]; 1.71–2.63) and median 2.1 μg/dL. The case group had average values of 9.01 μg/dL (CI; 6.07–11.96) and median values of 6.5 μg/dL with p-values < = 0.001. The case group reported the following more frequently: irritancy, bad mood, headache, memory losses, daylight drowsiness, myalgia, weakness, abdominal pain, joint pain, trembling, tingling limbs. There was statistical significance for the differences of symptoms frequencies and for odds ratio between groups.ConclusionsAlthough the mean lead levels found were lower than the current laboratory references, low levels have been associated with both rising morbidity and mortality. The WHO stated: “There is no known level of lead exposure that is considered safe”. In conclusion, this work showed that bullets retained in the body are not innocuous. There are impacts in the blood lead levels and symptoms related to it, even with few fragments, extra-articular located or existing with low blood lead levels.

Hematological indices of patients with retained lead pellets in the craniomaxillofacial region following gunshot wounds

“…This study shows that there were significantly higher BLLs in the test group than in the control group. This finding is in agreement with previous studies1819 where comparison of BLLs was done between those with and without retained lead missiles (pellets, bullets, and shrapnel) where higher BLL was seen in those with retained missiles in their bodies. This is expected since, in most developed and developing countries such as Nigeria, there is a reduction in environmental and occupational lead exposures due to the ban in leaded gasoline and the reduction in the use of lead in plumbing 20.…”

“…Although higher levels were seen in these groups, they were lower than the threshold value of 10 μg/dl. This cutoff value as defined by the CDC as a limit for an elevated BLL is primarily based on neurological toxicity 19. Recent work has shown that there is no level <10 μg/dl that is considered safe 22…”

Effect of bone fracture(s) on blood lead levels from retained lead pellets in craniomaxillofacial region

“…The mean BLL of the study subjects was higher than that of their control counterpart (Table 2). This result is similar to the findings of Araújo et al, 15 Nguyen et al, 17 Moazeni et al, 20 and Farrell et al 12 Following the absence of occupational and environmental exposure of both the patients and their control subjects, the only possible explanation for the higher levels of lead among the patients is undoubtedly the presence of retained missiles.…”

“…20 Furthermore, weapons that fire bullets are commonly seen in the developed countries when compared to developing countries were weapons that fire shots or pellets are commonly seen. 8 While the previous study 15,16 on fracture-related blood lead elevation risk factor was cross-sectional in nature, the present study uses a prospective cohort design, which obviates errors in measurements.…”

“…The usefulness of these questionnaires has been documented in published lead studies. 15 The information from the questionnaires was not for analysis but to rule out cofounders.…”