Dr Samuel Chu1, Dr Helen Douglas1, Dr Edward Raby1, Dr Anna Goodwin-Walters1, Dr Suzanne Rae1
1State Adult Burns Unit WA, Perth, Australia
The objective of this case report is to draw attention to the possibility of lead toxicity from lead-associated smoke inhalation injury, which has been suggested in existing literature. (Lahn et al., 2003; González Rendón et al., 2018; Sutunkova et al., 2020)
We present a 55-year old male patient who had been using an angle grinder in an enclosed warehouse to cut up and salvage some electronic parts from a computer, causing an explosion. These parts possibly contained lead. He had 55-60% total body surface area burns, as well as a singed beard, but no obvious airway burns. Primary and secondary survey were otherwise unremarkable.
He was intubated in the Emergency Department for increasing agitation and admitted to the intensive care unit. He had uncomplicated debridement and grafting on day 3. However, he continued to fail extubation secondary to agitation, eventually requiring a surgical tracheostomy on day 15. Despite spontaneous ventilation by day 18, the patient continued to require sedation for ongoing delirium, agitation, and confusion; despite three prior normal CT heads and an MRI brain. Marked right sided hypotonia was also noted. These symptoms improved slowly, resolving by day 36.
We note that agitation, confusion, muscle weakness, and other neurological symptoms are associated with acute lead toxicity. This case raises the possibility that lead toxicity could arise through smoke inhalation. Patients with abovementioned symptoms should be tested for lead levels to determine if chelation therapy is indicated.
Dr Samuel Chu is a Surgical Service Segistrar working in Western Australia with a keen interest in plastic surgery. He graduated from UWA with a Doctor of Medicine in 2017 and Bachelor of Commerce in 2010, and is also a member of the Institute of Chartered Accountants.