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Succimer Mitigates the Perioperative Risk for an Increase in Blood Lead Levels During Bulletectomy: A Case Report
Joseph M Kennedy1, Joanne C Routsolias2, Mark B Mycyk3
1Department of Emergency Medicine, University of Vermont Medical Center, Burlington, Vermont.
JBJS Case Connector
|June 15, 2023
Summary
Oral succimer effectively reduced elevated blood lead levels (BLL) in a patient needing surgery for retained bullet fragments. This offers a well-tolerated alternative to intravenous chelation for managing lead exposure during bulletectomy.
Area of Science:
- Orthopedic surgery
- Toxicology
- Pharmacology
Background:
- Elevated blood lead levels (BLL) pose risks, particularly in patients requiring surgical intervention.
- Retained bullet fragments are a potential source of chronic lead exposure.
- Surgical removal of fragments may increase BLL, necessitating management strategies.
Observation:
- A 38-year-old male presented with a tibial plateau fracture and elevated BLL due to bullet fragments retained for 21 years.
- The patient underwent surgery to remove the bullet fragments.
Findings:
- Oral succimer administration before and after surgery significantly reduced the patient's BLL from 58 to 15 μg/dL.
- Oral succimer proved to be an effective and well-tolerated alternative to parenteral (intravenous) chelation therapy.
- This approach mitigated the anticipated rise in BLL during the surgical procedure.
Implications:
- Oral succimer may be a viable alternative to intravenous chelation for managing lead exposure in surgical patients.
- Further research is warranted to establish optimal chelation protocols (route, timing, duration) for bulletectomy.
- This case highlights the long-term consequences of retained ballistic materials and the importance of addressing associated lead toxicity.
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