Lead poisoning from retained lead projectiles. A critical review of case reports.

Case reports demonstrate that embedded lead projectiles (bullets, pellets) have the potential to cause lead poisoning. They also show that the relationship between blood lead concentration and lead poisoning is the same as in lead poisonings of occupational origin and that latent periods between lodgement and the onset of lead poisoning varies from less than a half year to several decades. Nevertheless neither the quantitative relationships between projectiles and blood concentrations nor the number at risk and the number affected are known. The aim of this review is to show the limitations of case studies through the analysis of negative and positive case reports, diagnostic and monitoring methods, differences between bullets and pellets, and factors affecting the disintegration of projectiles and the distribution of released lead.