Lead Toxicity Due to Retained Bullet Fragments

It is estimated that between 50,000 and 60,000 patients in the United States per year are shot and consequently have retained bullet fragments. Lead is considered a poison and can be systemically absorbed from the retained bullet fragments. Between 70% and 90% of lead, that is not excreted, is stored subsequently in bone. Lead toxicity can result in neurological, cardiovascular, hematological, gastrointestinal, hepatic, psychiatric, and musculoskeletal dysfunction. It is reasonable to consider removal of all retained bullet fragments, as soon as possible, and monitor clinical symptoms and blood lead levels post-injury. Bone resorption from pregnancy, immobility, or aging, may result in lead toxicity in the future. Chelation has a small impact on overall total body lead levels.