From the Guidelines
Heavy metal testing is indicated when there is suspicion of toxic metal exposure or poisoning, particularly in individuals with unexplained neurological symptoms, cognitive decline, kidney dysfunction, or gastrointestinal issues that don't respond to standard treatments, as well as those with known occupational or environmental exposure to heavy metals 1.
Indications for Heavy Metal Testing
The following scenarios warrant consideration for heavy metal testing:
- Unexplained neurological symptoms, cognitive decline, kidney dysfunction, or gastrointestinal issues that don't respond to standard treatments
- Known occupational exposure (such as welders, battery manufacturers, or miners) to heavy metals like lead, as outlined in the recommendations for medical management of adult lead exposure 1
- Environmental exposure (living near industrial sites or old homes with lead paint)
- After acute high-dose exposure to heavy metals
Testing Methods
Testing typically involves:
- Blood samples for recent acute exposures
- Urine tests (often with a chelating agent like DMSA or EDTA) for chronic exposures, as recommended for individuals with blood lead concentrations between 10 and 19 µg/dL 1
- Hair and nail analysis may supplement these tests but shouldn't be used alone for diagnosis
Timing and Treatment
- The timing of testing is crucial - blood levels of many metals decrease rapidly after exposure ends, so testing should occur as soon as possible after suspected exposure
- Treatment depends on the specific metal involved and severity of toxicity, ranging from removal from the exposure source to chelation therapy in severe cases, as noted in the guidelines for the medical management of adult lead exposure 1
Prevention and Screening
Targeted screening of children for elevated blood lead concentrations is recommended if they are 12 to 24 months of age and live in communities or census block groups with ≥25% of housing built before 1960 or a prevalence of children’s blood lead concentrations ≥5 μg/dL, as outlined in the prevention of childhood lead toxicity guidelines 1
From the FDA Drug Label
INDICATIONS Penicillamine capsules are indicated in the treatment of Wilson's disease, cystinuria, and in patients with severe, active rheumatoid arthritis who have failed to respond to an adequate trial of conventional therapy. The diagnosis, if suspected on the basis of family or individual history or physical examination, can be confirmed if the plasma copper-protein ceruloplasmin** is less than 20 mg/dL and either a quantitative determination in a liver biopsy specimen shows an abnormally high concentration of copper (greater than 250 mcg/g dry weight) or Kayser-Fleischer rings are present
The indication for heavy metal testing is to confirm the diagnosis of Wilson's disease, which is characterized by an accumulation of copper in the body. Testing may include measurements of:
- Plasma copper-protein ceruloplasmin levels
- Quantitative determination of copper in a liver biopsy specimen
- Presence of Kayser-Fleischer rings 2
From the Research
Indications for Heavy Metal Testing
The following are indications for heavy metal testing:
- Current exposures to heavy metals such as lead and mercury can be identified through random urine samples 3
- Total body burden of heavy metals can be assessed through urine samples taken after using a heavy metal mobilizing agent 3
- Heavy metal testing can help identify which chelating agent will be most effective for a patient 3
- Possible absorption problems can be identified if oral agents are employed 3
- Intoxications with compounds of mercury, lead, and copper can be treated with chelating agents 4
- Inorganic lead poisoning can be treated with succimer (dimercaptosuccinic acid, DMSA) 5, 6
- Children with blood lead concentrations higher than 45 micrograms/dL can be treated with succimer 6
Conditions that May Require Heavy Metal Testing
Heavy metal testing may be required for: