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Management of lead foreign body ingestion
L F Durback1, G P Wedin, D E Seidler
1West Virginia Poison Center, West Virginia University School of Pharmacy, Charleston 25304.
Insights
Lead foreign body (PbFB) ingestion in children is generally safe if not retained in the GI tract. Two recent cases show mild symptoms and low blood lead levels, supporting this belief.
Area of Science:
- Pediatric Toxicology
- Gastroenterology
- Environmental Health
Background:
- Lead foreign body (PbFB) ingestion in children has been associated with severe outcomes, including lead intoxication and mortality.
- Current medical consensus suggests PbFB ingestion poses minimal risk of lead toxicity if the object is not retained within the gastrointestinal (GI) tract.
Observation:
- Two separate cases involved 9-year-old girls ingesting a PbFB.
- The first patient experienced mild, non-specific GI complaints with a peak blood lead level (BLL) of 15 mcg/dl.
- The second patient remained asymptomatic, with the highest recorded BLL at 22 mcg/dl.
Findings:
- Both patients successfully passed the PbFB via stool within a two-week period.
- Neither patient exhibited significant lead toxicity despite ingesting a PbFB.
- Observed blood lead levels remained below critical thresholds for toxicity.
Implications:
- These findings support the established belief that non-retained PbFBs pose a low risk for lead toxicity in pediatric patients.
- Management of PbFB ingestion can potentially align with protocols for other uncomplicated foreign body ingestions.
- Further clinical experience may refine treatment guidelines for pediatric PbFB ingestions.
Abstract:
Previous reports of lead foreign body (PbFB) ingestion by children include two cases of lead intoxication and two cases that resulted in death. It is generally accepted, however, that PbFB ingestion does not pose a risk of lead toxicity, provided that the PbFB is not retained in the gastrointestinal (GI) tract. Recent experience with two cases substantiates this belief. On separate occasions, two 9-year old girls ingested a PbFB. The first patient developed only mild, vague GI complaints. The highest reported blood lead level (BLL) was 15 mcg/dl. The second patient did not develop symptoms, and the highest reported BLL was 22 mcg/dl. Both patients passed the PbFB in the stool within two weeks. These cases suggest that PbFB ingestions can be treated in a manner similar to other uncomplicated foreign body ingestions.