The Other Problem With Bullets (Lead and Lead Poisoning from Bullets)

Get ready for a HEAVY subject, literally. Ryan and Toxo talk about the toxic mechanisms, signs of poisoning, and treatment of one of the worlds most ubiquitous poisons. This is a long, but interesting one, consider listening in chunks. Excellent Review SourcesCalello DP, Henretig FM. "Lead." In: Goldfrank's Toxicologic Emergencies, 10th ed, Hoffman RS, Howland MA, Lewin NA, et al (Eds), McGraw Hill Education, New York, 2015. p.1219.Toxic Substances Database for Lead: https://www.atsdr.cdc.gov/toxprofiles/tp.asp?id=96&tid=22Clinical Case from Today's ShowSevere lead toxicity from retained bullet fragments:Weiss D, Lee D, Feldman R, Smith KE. "Severe lead toxicity attributed to bullet fragments retained in soft tissue." BMJ Case Rep. 2017;2017. doi:10.1136/bcr-2016-217351Full Text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353372/History of LeadLead’s abundance has increased over time due to radioactive decay: https://iopscience.iop.org/article/10.1086/375492Its use spans currency, cosmetics, aqueducts, and even wine, contributing to societal impacts like the fall of Rome: https://pubmed.ncbi.nlm.nih.gov/14261844Lead in society overview: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6522252/Common Sources of Lead ExposureLead Paint: Up to 50% lead until 1940; still present in millions of homes.Soil: Contaminated by tetraethyl leaded gasoline (introduced by Thomas Midgley): https://interestingengineering.com/thomas-midgley-jr-the-man-who-harmed-the-world-the-mostLead Piping:EPA Lead and Copper Rule: https://www.epa.gov/sites/production/files/2016-10/documents/508_lcr_revisions_white_paper_final_10.26.16.pdfTraditional Medicines: Ayurveda: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2538609/Kohl (cosmetics): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1567936/Bullets: https://pubmed.ncbi.nlm.nih.gov/30939573/The "Lead Crime Hypothesis": https://pubmed.ncbi.nlm.nih.gov/27035924/Clinical EffectsBen Franklin’s "Dangles and Bellyaches": https://pubmed.ncbi.nlm.nih.gov/22910081Colic/constipation.Neuropathy.Neurocognitive/Behavioral Effects:IQ reduction, visual-spatial impairment, reduced processing speed, and irritability.Impacts in young children: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3909981/Chronic Conditions:Kidney and vascular disease: https://www.atsdr.cdc.gov/toxprofiles/tp13-c2.pdfHematologic effects (e.g., hemolytic anemia): https://www.atsdr.cdc.gov/toxprofiles/tp13-c2.pdfBurton lines (sulfate deposits): https://www.amjmed.com/article/S0002-9343(12)00286-0/pdfLead lines (metaphyseal calcification): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1912933/Toxic MechanismsBinds to sulfhydryl groups.Acts as a divalent cation, interfering with numerous enzymatic processes.Comprehensive overviews:Goldfrank’s Toxicologic Emergencies, 10th ed.https://www.atsdr.cdc.gov/csem/csem.asp?csem=34&po=10Treatment OverviewChelation Therapy:BAL: Painful IM injection; contraindicated in G6PD deficiency.https://www.sciencedirect.com/science/article/pii/S0041008X99987252Ca2NaEDTA: IV; used for levels >70 µg/dL or encephalopathy.https://www.sciencedirect.com/science/article/abs/pii/S0013935184710632Succimer: Oral; ensure lead has passed the small intestine before starting.https://www.sciencedirect.com/science/article/abs/pii/S0013935184710632Management Based on Blood Lead Levels:Kids: https://www.cdc.gov/nceh/lead/advisory/acclpp/actions-blls.htmAdults: https://pubmed.ncbi.nlm.nih.gov/17431500/If You Encounter Lead ExposureConfirm elevated capillary blood lead with venous testing.Call your toxicologist or poison center for guidance.Thanks for listening!A Morel DilemmaSupport the showReview the show where ever your listeningGet Messages from Toxo (Join the Newsletter!)Join as a supporting memberAd free episodesBonus content and early accessDiscounts and give aways on GOTA PICCEM Mushroom card gameThe GOTTA PICCEM Poisonous Mushroom Game!The Poisonus Fungus Amongus Children's Book!Full book reading (6 minutes!)Tox trinkets (Rep the show at home!)Reach the showEmail: [email protected] Show ResourcesRyan's Medical Games and ResourcesShow Website