title: Retained Lumbar Bullet: A Case Report of Chronic Lead Toxicity and Review of the Literature.
abstract: BACKGROUND
  Lead toxicity from retained bullet fragments is difficult to both predict and diagnose, but important to treat early, given the potential severity of disease. Blood lead levels > 25 μg/dL and 40 μg/dL are considered toxic in children and adults, respectively. Symptoms may range from nonspecific constitutional symptoms to seizures and coma. Chelation is the mainstay therapy for lead poisoning and levels to treat depend on patient age, blood lead levels, and the presence of symptoms. CASE
  
  
  METHODS
  We present the case of a woman with symptoms of severe lead toxicity from 20-year-old retained bullet fragments. She had been seen by multiple providers for evaluation of each symptom, but a unifying diagnosis had not been found. After identifying this complication, she was treated appropriately and more serious complications were prevented. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We present this case to increase awareness among emergency physicians of lead toxicity in patients with a seemingly unrelated constellation of symptoms and a history of a previous gunshot wound with retained bullet or bullet fragments.
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Nirma D
authors.initials: ND
authors.lastname: Bustamante
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts.
authors.forename: Wendy L
authors.initials: WL
authors.lastname: Macias-Konstantopoulos
mesh_terms: D000328:Adult; D015913:Chelation Therapy; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D005547:Foreign Bodies / Q000150:complications* / Q000601:surgery; D006801:Humans; D007854:Lead / Q000097:blood / Q000633:toxicity*; D007855:Lead Poisoning / Q000150:complications / Q000209:etiology* / Q000628:therapy; D008159:Lumbar Vertebrae / Q000002:abnormalities* / Q000293:injuries; D014948:Wounds, Gunshot / Q000150:complications
chemical_list: D007854:Lead
keywords: chelation therapy; lead toxicity; plumbism; retained bullet