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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.
Case:
A 38-year-old man with a tibial plateau fracture required treatment for elevated blood lead level (BLL) from retained bullet fragments in the same knee from a gunshot wound 21 years earlier. Oral succimer presurgery and postsurgery decreased the BLL from 58 to 15 μg/dL.
Conclusion:
Parenteral chelation has been previously recommended to mitigate an increase in BLLs during surgical intervention to remove bullet fragments. Oral succimer was an effective and well-tolerated alternative to intravenous chelation. Further research is needed to determine the optimal route, timing, and duration of chelation in patients with elevated BLL in need of bulletectomy.
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