Severe lead poisoning after ingestion of a bullet has been described but
is generally associated with prolonged GI transit time (greater than 2 weeks).
In children who pass the bullet in less than 2 weeks, severe lead poisoning is
generally not seen. (reports dated pre-1991 will state that no lead poisoning
occurred,but lead poisoning was defined differently then and in some reports
lead did rise to the 20's.) Lead levels probably do not rise significantly
because the surface area of an intact single bullet is relatively small so
unless there is prolonged GI transit, there is relatively little lead available
for absorption. There was a recent case of a child who swallowed an intact
civil war era musket shot who did develop lead levels to the 50's. So an older
lead object may be more prone to disintegration and developing dust and
increasing its surface area enough so that significant amounts can be absorbed.
Nutritional factors such as iron deficiency, calcium or phosphorus deficient
diet, rickets, high fat diets will increase the amount of lead absorbed, it may
be worthwhile to make sure the child doesn't have any of these. And lead levels
should be checked baseline and lead levels followed (the risk of severe lead
poisoning is very small, but low level lead poisoning (20 ug/dL) may occur.)
As a reference there is Durback et al, J Tox Clin Tox 1987 Vol 27 p 173.
The civil war era musket ball report was an abstract in the 1995 North
American Congress of Clinical Toxicology meeting.
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