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Treatment of Chronic Lead Toxicity With Succimer: A Case Series of 2 Adults With Retained Lead Shotgun Fragments

Cyrus, Rachel M. MD*; Woller, Scott C. MD†‡; Stevens, Mark H. MD†‡; Pugh, Mary R. APRN, RN; Stevens, Scott M. MD†‡; Edwards, Corwin Q. MD†‡

The American Journal of Forensic Medicine and Pathology: September 2011 - Volume 32 - Issue 3 - p 236-238
doi: 10.1097/PAF.0b013e318219ca93
Case Reports

Few recommendations exist for management of chronic lead toxicity in instances when the source of lead exposure cannot be removed.

Cases: We describe 2 patients who had shotgun wounds resulting in multiple retained lead pellets. They developed elevated blood lead levels and were treated with 2 weeks of high-dose oral succimer before being placed on maintenance oral succimer therapy with the goal of sustaining suppressed lead levels.

Discussion: Retained lead pellets have been associated with increasing blood lead levels over time. Chronic lead toxicity can cause significant morbidity. Few treatments for lead toxicity are available, and there is scarce data on maintenance therapy for patients who have large numbers of retained shotgun pellets.

Conclusions: This case series documents 2 patients who continue on maintenance oral chelation therapy with succimer in an effort to prevent the sequelae of chronic lead toxicity by maintaining blood lead levels less than 20 μg/dL.

From the *Northwestern Memorial Hospital, Chicago, IL; †University of Utah, Salt Lake City; and ‡Intermountain Medical Center, Murray, UT.

Manuscript received October 17, 2008; accepted January 4, 2009.

No funding was used to support this report.

This represents an original publication neither published nor under consideration elsewhere. All authors participated in manuscript preparation.

The authors report no conflicts of interest.

Reprints: Scott C. Woller, MD, Intermountain Medical Center, 5121 Cottonwood St, PO Box 577000, Murray, UT, 84157-7000. E-mail:

© 2011 by Lippincott Williams & Wilkins.