McNutt T K, Chambers-Emerson J, Dethlefsen M, Shah R
Florida Poison Information Center, Tampa General Hospital, 33601, USA.
Vet Hum Toxicol. 2001 Oct;43(5):288-9.
A 45-y-o male with a history of schizophrenia was admitted to a local VA psychiatric unit. Five days later, endoscopy due to abdominal pain, gastrointestinal bleeding and blood hemoglobin of 5.6 g/dL revealed bullets in the stomach. On subsequent radiograph, > 50 bullets were visualized in the stomach and intestines. Poison Center recommendations included whole bowel irrigation and a blood lead level. After poor results with gastrointestinal decontamination and a repeat radiograph showing > 100 cartridges, surgical intervention was considered but not performed due to perceived risk of bullet detonation from electrocautery. The blood lead was reported as 391 mcg/dL. Calcium EDTA therapy was initiated, followed by aggressive gastrointestinal decontamination. Four days of whole bowel irrigation facilitated passage of 206 cartridges over the next 10 days. The patient was discharged on a 14-day course of 600 mg Succimer tid to treat the bone lead deposits and blood lead level of 49 mcg/dl. An outpatient visit 6 w later showed the blood lead level had dropped to 24 mcg/dl. Aggressive gastrointestinal decontamination and calcium EDTA and Succimer administration successfully treated an ingestion lead bullets and the resulting lead poisoning.
一名45岁有精神分裂症病史的男性被收治到当地退伍军人事务部的精神科病房。五天后，因腹痛、胃肠道出血以及血红蛋白水平为5.6 g/dL而进行的内镜检查发现胃内有子弹。在随后的X光片上，在胃和肠道中发现了50多发子弹。中毒控制中心的建议包括进行全肠道灌洗并检测血铅水平。在胃肠道去污效果不佳且复查X光片显示有100多发子弹后，考虑进行手术干预，但由于担心电灼可能引发子弹爆炸而未实施。报告的血铅水平为391 mcg/dL。开始进行依地酸钙钠治疗，随后积极进行胃肠道去污。四天的全肠道灌洗促使在接下来的10天内排出了206发子弹。患者出院时接受为期14天、每天三次、每次600毫克青霉胺的治疗，以治疗骨铅沉积和血铅水平为49 mcg/dl的情况。六周后的门诊复查显示血铅水平已降至24 mcg/dl。积极的胃肠道去污以及依地酸钙钠和青霉胺的给药成功治疗了摄入铅弹及由此导致的铅中毒。
