The onset of lead poisoning can occur with a few weeks to many years after the event.
Risk factors for lead poisoning:
(1) uncoated/unjacketed projectile (naked lead)
(2) large surface area (deformed, fragmented, maximum with buckshot)
(3) location within a joint (synovial fluid effective in dissolving the lead, constant abrasion)
(4) duration of exposure
(5) failure to encapsulate the projectile in fibrous tissue
(6) presence of a fracture caused by the projectile, which either fragments or become deformed (McQuirter). Lead fragments within the bone may be harder to encapsulate with fibrous tissue.
(7) sudden event causing release of lead from body stores (shock, sepsis, hypermetabolic state)
Any patient with a retained lead missile should have the serum lead level monitored, especially if there are symptoms that could be due to lead poisoning.
The foreign body should be removed if possible. The patient should be treated with chelation therapy prior to surgery in order to reduce the risk of acute postoperative lead poisoning associated with mobilization from any lead body stores (Ellenhorn).
