Background: Poison centers are commonly consulted on cases of ingested lead foreign bodies (LFBs), particularly fishing sinkers. Often they are managed expectantly and the foreign bodies are allowed to pass in the stool. We present a case of an ingested LFB that developed toxic lead levels after only hours of exposure.
Case report: An asymptomatic 4-year-old boy presented 20 min after ingesting a lead fishing sinker. An X-ray revealed the sinker to be in the stomach, and no other foreign bodies (FBs) were identified. Expectant management was planned. The next morning the boy returned complaining of abdominal pain. A repeat X-ray revealed the FB remained in the stomach. After transfer to a regional specialty center the FB was removed via endoscopy 19 h after ingestion. A venous blood lead level (BLL) returned elevated at 68 mcg/dL. The boy’s home was built in the 1980s and he had no history of pica. A BLL from 1 year prior was <5 mcg/dL. The boy was hospitalized and chelated with succimer. A BLL 2 days later was 38 mcg/dL. The child was discharged home. Final BLL 76 days after ingestion was 14 mcg/dL. Nine months later the boy had no sequelae.
Discussion: Pediatric fishing sinker ingestions are commonly called to poison centers. However, literature on this topic is quite sparse, with only three previous pediatric cases reported. In one case the sinker was removed within 3 h of ingestion and the child had nontoxic lead levels. The other two cases were children who were found to have multiple sinkers present on X-ray and likely acute on chronic ingestions. Previously it was generally accepted that poisoning from ingested LFBs requires the FB to be present for an extended period of time. Cases have been reported of toxic lead levels within hours of ingestion; however, many of these cases were likely acute on chronic ingestions. Our case is unique in that this boy had an isolated exposure to one lead fishing sinker that resulted in a toxic lead level in a matter of hours. In light of this case, the practice of expectant management in LFB ingestions may result i lead toxicity, and may no longer be appropriate.
Conclusion: Toxic lead levels can occur from ingested lead foreign bodies within hours of ingestion, and expectant management may be inadequate.