Lead Chelation Treatment - why not routine in adults over a certain age

[DSeid]

To illustrate the difficulties that management presents, a recent case report with discussion:

“Heavy Metal”: Management of lead toxicity following a gunshot injury with...

Concerning lead poisoning resulting from retained projectiles or fragments of bullets, the likelihood of toxicity is generally low when the fragments are situated within soft tissue, as they tend to become encapsulated and isolated by scar tissue formation. Conversely, some studies have shown that intra-articular lead fragments, in particular, should be removed due to the potential for metal degradation and increased absorption through the synovial [2], [4], [5]. …

… the utilization of chronic chelation therapy is hindered by potential toxicity, diminished long-term effectiveness, and insufficient evidence [3], [6] To our knowledge, no certain information concerning chronic treatment of bullets that cannot be surgically removed is available. We present the case of a patient with a not-surgically removable source of lead. …

Bolding mine.

Briefly, 81 year old make hunting accident bullet fragments knee. Stabilized and had significantly elevated lead levels over the next weeks. Debridement and repair done as best as possible but still fragments unable to be removed. Options discussed included amputation, declined. A few days later mental decline with slurred speech. Chelation not yet started as supplies not yet arrived. Symptoms quickly resolved before chelation supplies came. Felt not to be from lead toxicity. The decision was made to NOT do chelation and his elevated levels slowly decreased:

with a plateau around 35–40 µg/L eight months after the accident, and no documentation of any signs or symptoms of lead poisoning. The patient remains fully autonomous and active, and the follow-up is ongoing

Some interesting decision making processes. Clearly it can be … complicated.

[Tim_T-Bonham.net]

@puzzlegal

I’ve read that lead leaching out of the bones of old people who are losing bone mass can be a medical problem in the elderly.

But i dunno if chelation even helps remove lead that’s been bound up in bones.

But chelation also removes calcium. And already weakened bones due to low calcium (osteoporosis) is much more common in elderly people.