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You can imagine our heartache when I tell you our teenage son was involved in a gang-related incident that left him with a gunshot wound to the knee. The surgeon was careful to get all the bullet fragments out. Is there still a chance he could get lead poisoning?

Bullet removal at the time of the initial surgery is accompanied by lots and lots of irrigation of the area. The surgeon uses a saline (salt) solution to flush the area thoroughly. Much time is spent making sure all debris and possible causes of contamination are removed. It isn't always necessary to remove bullet fragments. Often the body works very well to wall off the area around the bullet and protect the nearbly soft tissues. Lead toxicity is more likely when bullet fragments remain in the joint synovial fluid. The lead can leak into the joint fluid which is how it enters the blood stream. So any bullet fragments in the knee joint are carefully and completely extracted. The body will eliminate any remaining lead through the liver and kidneys. It takes about 30 days for the body to clear itself of this substance. So if symptoms of lead toxicity are going to occur, it usually isn't right away. The patient and family are advised to watch for symptoms such as fatigue, headache, or new onset of joint pain. There can be gastrointestinal symptoms such as abdominal pain, nausea, vomiting, and/or constipation. Some patients report difficulty with memory, shortened attention span, and even unusual behaviors. Blood tests may show a particular kind of anemia called microcytic hypochromic anemia. If the kidneys cannot excrete all of the lead, kidney failure can develop. Your son should remain under the care of his primary physician with periodic visits to the surgeons who operated on him as well. Don't hesitate to report any unusual or new signs or symptoms. The earlier lead toxicity is recognized, the sooner treatment can be started and the better the response.

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