Compendium May 1999
EXOTICS ROUNDS
Lead and Zinc Toxicosis from a
Retained Projectile in a Bird
ABSTRACT: A lesser sulfur-crested cocka-
too was evaluated because of a history of
falling off its perch, a clinical change sug-
gestive of generalized weakness or neu-
ropathy. Radiographs of the head indicat-
ed a pellet-shaped, radiodense foreign
body partially imbedded in the frontal
bone. The blood lead level in the bird was
mildly elevated (0.4 ppm), and the serum
zinc level was high (19 ppm). The bird re-
turned to a clinically stable state after
chelation therapy and surgical removal of
the pellet.
Cheryl B. Greenacre, DVM,
Diplomate ABVP (Avian)
Branson W. Ritchie, DVM, PhD,
Diplomate ABVP (Avian)
University of Georgia
College of Veterinary Medicine
Athens, Georgia
A
n adult, male lesser sulfur-
crested cockatoo (Cacatua
sulphurea sulphurea) was pre-
sented to the University of Georgia
College of Veterinary Medicine
Teaching Hospital with a history of
falling off its perch and an inability
to grasp with the feet for 15 minutes
after falling. A similar episode may
have occurred 2 days earlier. The
client reported that the bird other-
wise had a normal attitude, appetite,
and droppings. The bird had been
purchased at a pet store 4 years earli-
er and was housed within an en-
closed porch in a 1.5 × 1 × 1–m,
20TH ANNIVERSARY Small Animal/Exotics
brass-plated, commercial bird enclo- radiographic evidence that the interior
sure. A polyvinylchloride pipe was of the cranium was affected. Whole-
available as a perch. Metallic materi- body radiographs showed no other
als containing lead or zinc were not metallic densities, but hepatomegaly
observed within the enclosure, and and mild proventricular dilation were
the bird did not have unsupervised present. The client was unaware of
access to the house. A cockatiel, dog, any circumstance in which the bird
and cat also resided in the household could have been exposed to a pellet-
and were clinically sta-
ble. The bird was fed a
■ The surface area of a foreign body and the puri-
commercial parrot-seed
ty of the lead it contains contribute directly to
mix and had access to
KEY POINTS
its toxic potential.
a mineral block.
■ Lead projectiles degrade faster when in contact
with synovial fluid or fluid within a pseudocyst.
Clinical Findings
On physical exami- ■ Basophilic stippling and cytoplasmic vacuoli-
zation of erythrocytes are uncommon in birds
nation, the bird was
with lead toxicosis.
noted to have an open,
import-type band on
one leg. The bird was bright and alert shaped projectile during the 4 years he
but thin (329 g). An 8 × 10–mm, had owned the bird.
firm, immobile, dark, subcutaneous Abnormalities noted on a com-
mass was present 1 cm caudal to the plete blood count included hetero-
crest and dorsal to, but partially in- philia (92%; reference interval, 55% to
volving, the frontal bone on the mid- 80%), leukocytosis (13,100 cells/µl;
line. Radiographs of the head indicat- reference interval, 5000 to 11,000
ed a pellet-shaped, radiodense foreign cells/µl), lymphopenia (3%; reference
body partially imbedded in the interval, 20% to 45%), and mild ane-
frontal bone (Figure 1). There was no mia (33%; reference interval, 38% to
Exotics Rounds deviates a bit from the normal content of Compendium.
Because little information has been published in many areas of exotic animal
medicine, emerging disease issues are frequently as important to clinicians as are
review articles. We hope that the format of this new column will help to
disseminate needed information to practitioners who treat exotic animals.
Readers interested in submitting papers for Exotics Rounds can contact Dr.
Branson Ritchie, College of Veterinary Medicine, University of Georgia,
Athens, GA 30602; 706-542-6316; fax 706-542-6460; email britchie@
cvm.vet.uga.edu.
Small Animal/Exotics
Figure 1A
Figure 1B
Figure 1—(A) Lateral and (B) antero-
posterior radiographs of the skull show-
ing a metallic density with a size and
shape consistent with a pellet 1 cm
caudal to the crest and dorsal to, and
minimally involving, the frontal bone.
48%). Results of a biochemical anal-
ysis were normal except for a mildly
elevated lactate dehydrogenase (691
U/L; reference interval, 220 to 550
U/L) and mildly decreased albumin
(1.5 g/dl; reference interval, 1.8 to 3.1
g/dl) and uric acid (3.0 mg/dl; refer-
ence interval, 3.5 to 10.5 mg/dl).
Blood and serum were analyzed by
the Toxicology Division of the
Louisiana Veterinary Medical Diag-
nostic Laboratory for lead and zinc.
The blood lead level was considered
mildly elevated (0.4 ppm; reference
20TH ANNIVERSARY
interval, less than 0.2 ppm), and the
serum zinc level was considered
highly elevated (19 ppm; reference
interval, less than 2 ppm).
Treatment
The bird was hospitalized, and
intramuscular calcium ethylenedi-
amine tetraacetic acid (EDTA; 30
mg/kg [14 mg/lb] every 12 hours)
was administered for 6 days before
surgery. The bird’s appetite im-
proved dramatically within 3 days of
initiating chelation therapy.
For surgical removal of the mass,
general anesthesia was induced with
isoflurane via a face mask and was
maintained through a 3.5-mm, un-
cuffed endotracheal tube. The surgi-
cal area was prepared with chlorhexa-
dine scrub and warm sterile saline
according to published procedures.1
A 1.5-cm incision, centered over the
mass, was made with bipolar radio-
surgical forceps. A cystlike structure
was encountered and incised; mini-
mal hemorrhage occurred. The pellet
was grasped with a towel clamp and
gently removed. The area was copi-
ously lavaged with warm (37.8˚C),
sterile saline. The cystlike structure
and skin were closed separately with
4-0 polydiaxanone suture in a simple
continuous pattern. The excised pel-
let had a roughened, dull surface.
No postoperative complications
were encountered, and the patient
was discharged the following day.
The client was instructed to return
the bird immediately if any neuro-
logic signs recurred, the bird’s ap-
petite decreased, or the surgery site
became swollen or discolored or any
drainage was noted. Otherwise, the
client was to return the bird in 1
month for determination of post-
surgical blood lead and serum zinc
levels.
Follow-Up
The bird was presented for evalua-
tion 10 weeks after surgery, and the
client believed that it was more ac-
Compendium May 1999
tive than previously. At this time, the
blood lead level was within estab-
lished limits (0.03 ppm), and the
serum zinc level was considered high
normal (2.0 ppm). The projectile
was analyzed by the University of
Georgia Chemical Analysis Laborato-
ry and found to contain 478,200
ppm of lead and 47 ppm of zinc.
Discussion
Lead and zinc toxicoses are com-
monly reported in captive and free-
ranging birds and are usually caused
by inadvertent ingestion of metal.1
The uptake of heavy metals from re-
tained projectiles in soft tissue is gen-
erally thought to be minimal; howev-
er, it can occur.2–4 The purity of lead
in a foreign body and its surface area
contribute directly to its toxic poten-
tial. In humans, an average of 17
years is required for a single bullet to
cause lead toxicosis, whereas shrapnel
can cause toxicosis in an average of
10 years and buckshot can induce
toxicosis in as few as 2 days or as
long as 2 years (average, 8 months).3,4
Lead toxicosis from a retained projec-
tile has been reported in two psitta-
cine birds and has been experimen-
tally induced in pigeons.5 Lead shot
implanted into the subcutaneous and
muscular tissues of pigeons decreased
delta-aminolevulinic acid dehydratase
levels, suggesting systemic absorption
of lead into the bloodstream.1 In a
study using ducks, the blood and tis-
sue levels of lead did not increase
within 1 year after lead shot was im-
planted in the pectoral muscles.6
The mechanism of redistribution
of lead from a soft tissue site to the
bloodstream has yet to be explained.
It has been suggested that lead may
either dissolve into a soluble form
and diffuse into the bloodstream
and/or it may be oxidized to lead
dioxide that is then phagocytized by
macrophages and enters the blood-
stream. The latter mechanism has
been documented in humans who
inhaled lead dioxide dust.4
Compendium May 1999 20TH ANNIVERSARY
In humans, and experimentally in dogs, lead projectiles
have been shown to degrade faster when in contact with
synovial fluid or fluid within a pseudocyst.3,4,7,8 The mecha-
nism for the enhanced degradation is unknown but is
thought to be associated with an undefined caustic effect of
the fluid and the constant movement that occurs in a joint
space. It has been shown in humans that the fluid within
metal-induced pseudocysts has very high lead levels (as high
as 18.0 mg/g).3 It is therefore of the utmost importance
during surgical removal of lead foreign bodies to prevent
spillage of pseudocyst fluid and to copiously lavage the
surgery site.4,5 In the case reported here, the pellet was
lodged approximately 1 cm caudal to the nasofrontal joint,
which is a synovial joint in psittacine birds. The joint itself
did not appear to be penetrated, and thus synovial fluid
probably did not contribute to the dissolution of this pellet.
However, the fluid within the pseudocyst may have helped
dissolve metals in the pellet. Crest movement may have also
contributed to wearing of the surface of the pellet.
We are unaware of any reports of zinc toxicosis caused
by a foreign body retained in the soft tissue of any species.
Zinc and aluminum were found to be relatively nonreac-
tive when experimentally placed in the subcutaneous, mus-
cular, peritoneal, and mesenteric tissue of rats.9
In this case, we speculate that the pellet was introduced
before the bird’s capture from the wild, suggesting it is
possible for free-ranging birds to be affected by retained
lead or zinc projectiles. Stress was considered the most
likely cause of the heterophilic leukocytosis and lymphope-
nia noted in this bird. Although basophilic stippling and
cytoplasmic vacuolization of erythrocytes are observed in
some mammals with lead toxicosis, it has not been consis-
tently observed in birds and was not noted in this case.
Anemia and elevated lactate dehydrogenase activity, as oc-
curred in this cockatoo, have been reported with lead and
Small Animal/Exotics
zinc toxicosis.1 Proventricular dilation, which is thought to
be caused by partial paralysis of the ganglia of the proven-
triculus, has also been reported in cases of heavy metal tox-
icosis.10
Patients with chronic lead toxicosis may require chela-
tion therapy before surgery. Higher postoperative morbidi-
ty and mortality were described in humans with lead toxi-
cosis and in dogs with zinc toxicosis if chelation therapy
was not initiated before surgery.4,11 It is theorized that the
stress of surgery mobilizes stored lead from bone.4
References
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Harrison LR (eds): Avian Medicine: Principles and Application. Lake
Worth, FL, Wingers Publishing, 1994, pp 1030–1052.
2. Manton WI, Thal ER: Lead poisoning from retained missiles—An
experimental study. Ann Surg 204(5):594–599, 1986.
3. Linden MA, Manton WI, Stewart RM, et al: Lead poisoning from
retained bullets—Pathogenesis, diagnosis and management. Ann
Surg 195(3):305–313, 1982.
4. Bratton GR, Kowalczyk DF: Lead poisoning, in Kirk RW (ed): Cur-
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Saunders Co, 1989, pp 145–149.
5. Harrison GJ: Toxicology, in Harrison GJ, Harrison LR (eds): Clini-
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6. Sanderson GC, Anderson WL, Foley GL, et al: Effects of lead, iron,
and bismuth alloy shot embedded in the breast muscles of game-farm
mallards. J Wildl Dis 34(4):688–697, 1998.
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shot injuries. S Afr Med J 73:580–582, 1988.
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a gunshot wound. Pediatric 77(3):413–416, 1986.
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tissues. J Trauma 33(1):14–18, 1982.
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LR (eds): Avian Medicine: Principles and Application. Lake Worth,
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secondary to zinc toxicity in dogs. Vet Hum Toxicol 33(6):579–583,
1991.