Gastric location

If an ingested lead object is seen in the stomach on X-ray, the urgency for removal depends on the duration since ingestion.

If it has been less than 48 hours since ingestion, and the lead object is seen in the stomach, the patient can be monitored and requires a repeat X-ray at 48 hours after the time of ingestion. Use a proton-pump inhibitor at the standard dose for gastro-oesophageal reflux disease to reduce lead absorption in the acidic stomach environmentFergusson, 1997. If the object is still seen in the stomach on the repeat X-ray, refer the patient for endoscopic removal. If the object has moved past the stomach on the repeat X-ray, see Intestinal location for management.

If it has been more than 48 hours since ingestion, and the lead object is seen in the stomach, urgently refer the patient for endoscopic removal. Consult a clinical toxicologist about whether to measure the whole blood lead concentration.