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Heavy Metals

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Also known as: Toxic Metals
Formal name: Heavy Metals Panel
Related tests: Lead, Mercury, Iron, Copper

At a Glance

Why Get Tested?

To screen for, detect, and monitor excessive exposure to specific heavy metals

When to Get Tested?

Periodically when you work with heavy metals, or when your doctor suspects that you may have been exposed

Sample Required?

A blood sample drawn from a vein in your arm or a 24-hour urine sample; rarely, a hair sample, tissue sample, or other body fluid sample

Test Preparation Needed?

None

The Test Sample

What is being tested?

A heavy metals panel is a group of tests that measures the quantity of specific, potentially toxic metals in the blood, urine, or more rarely in the hair or other body tissue or fluid. A laboratory may offer several different groupings of heavy metals panels as well as tests for individual metals. The most common combination includes lead, mercury, and arsenic. Other panels may include one or more additional metals, such as cadmium, copper, or zinc. A doctor will select which metals to test for based upon what a person may have been exposed to in addition to clinical symptoms.

The term "heavy metals" is loosely defined. It is related to the periodic table of elements and refers to a variety of elements with high density or metallic properties. These elements are found naturally throughout the environment and are also used by industries to manufacture a wide range of common products. Some of them, such as iron, copper, selenium, molybdenum, and zinc, are required in trace amounts by the body for normal function but can be toxic at higher levels. Significant concentrations of any of the heavy metals can be irritating or damaging to the body and can contaminate soil, air, food, and water, persisting indefinitely in the environment. Because they are a source of potential injury, the term "heavy metals" is frequently used interchangeably with the term "toxic metals."

The signs and symptoms that a person may experience depend upon the type of metal, its form, the quantity, the length of exposure, the type of exposure, the age of the person, and the person's general state of health. Some metals are much more toxic than others, and one form of a metal may be more harmful than other forms, such as an organic versus an inorganic metal compound. How a person is exposed can influence the amount of metal absorbed and the part(s) of the body that are affected. For example, a metal that does little when it is held in someone's hand, or is only moderately harmful and poorly absorbed when swallowed, may be much more toxic and cause severe lung damage when its vapors are inhaled.

Severe acute exposure can cause damage and, in some cases, can be life-threatening, but moderate exposures over time should also be monitored. The body is able to process small amounts of heavy metals, but moderate to large quantities can accumulate in the kidneys, liver, bones and brain. Some metals are considered carcinogenic – they increase the risk of developing cancer – and some can affect the body's ability to produce red and white blood cells. Fetuses and young children are at the highest risk because exposures to low or moderate concentrations can affect physical and mental development and can permanently damage the organs and brain. Many of the metals can be passed from the mother to the fetus, and some can be passed to the infant in breast milk.

How is the sample collected for testing?

Heavy metal testing is usually performed on a blood sample obtained by inserting a needle into a vein in the arm or on a 24-hour urine collection. Special metal-free blood or acid-washed urine containers are used to minimize the potential for sample contamination by any outside sources of metal.

Urine and blood can both be used for heavy metal testing, but they do not necessarily test for the same forms of a metal. For instance, methylmercury – an organic highly toxic form of mercury found in fish – can be detected in the blood but not in urine. Urine is the preferred sample for measuring inorganic forms of mercury and for measuring arsenic.

Hair and fingernail analysis can give an indication of exposure that has occurred over time or in the past but does not show recent exposures. Blood and urine will reflect exposures that are chronic or that have happened in the last few days.

In rare cases, a biopsy will be performed to obtain a tissue sample for testing.

NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.

Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

The Test

Common Questions

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Article Sources

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

Sources Used in Current Review

Methylmercury poisoning. (Updated 2013 Mar 22). MedlinePlus Medical Encyclopedia. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/001651.htm. Accessed on 5/21/13.

Soghoian, S. and Sinert R. (Updated 2011 May 6). Heavy Metal Toxicity. eMedicine Medscape Reference. Available online at http://emedicine.medscape.com/article/814960-overview#a0199 through http://emedicine.medscape.com. Accessed on 5/14/13.

Martin, C. J., Werntz C. L., and Ducatman A. M. (2004 Dec). The interpretation of zinc protoporphyrin changes in lead intoxication: a case report and review of the literature. National Center for Biotechnology Information PubMed. Available online at http://www.ncbi.nlm.nih.gov/pubmed/15576877 through http://www.ncbi.nlm.nih.gov/pubmed. Accessed on 5/14/13.

Centers for Disease Control and Prevention. Lead Prevention Tips. (2012 June 25 Updated). Available online at http://www.cdc.gov/nceh/lead/tips.htm through http://www.cdc.gov. Accessed on 5/21/13.

China To Review Report Of Cadmium In Kid's Jewelry. By Jeremiah Marquez, AP Business Writer, 01/12/2010. Available online at http://www.manufacturing.net/news/2010/01/china-to-review-report-of-cadmium-in-kids-jewelry through http://www.manufacturing.net. Accessed May 2013.

'One third of Chinese toys contain heavy metals'. By Malcolm Moore, Shanghai and James Hall, 08 Dec 2011. The Telegraph. Available online at http://www.telegraph.co.uk/news/worldnews/asia/china/8944028/One-third-of-Chinese-toys-contain-heavy-metals.html through http://www.telegraph.co.uk. Accessed May 2013.

Sources Used in Previous Reviews

(Updated 2008 August 07). U.S. Department of Labor Occupational Safety and Health Administration, Toxic Metals. Toxic Metals [On-line information]. Available online at http://www.osha.gov/SLTC/metalsheavy/index.html through http://www.osha.gov. Accessed 1/25/09.

Soghoian, S. and Sinert, R. (2008 July 18). Toxicity, Heavy Metals. eMedicine [On-line information]. Available online at http://emedicine.medscape.com/article/814960-overview through http://emedicine.medscape.com . Accessed 1/18/09.

(1999 April 14). OSHA Regulated Toxic Metals. U.S. Department of Labor OSHA Safety and Health Topics [On-line information]. Available online at http://www.osha.gov/SLTC/metalsheavy/regulated.html through http://www.osha.gov. Accessed 1/25/09.

(2006 September). Aluminium. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts22.pdf through http://www.atsdr.cdc.gov. Accessed 1/25/09.

(1995 September). Antimony. ATSDR ToxFAQs [On-line information]. PDDF available for download at http://www.atsdr.cdc.gov/tfacts23.pdf through http://www.atsdr.cdc.gov. Accessed 1/25/09.

(2007 August). Arsenic. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts2.pdf through http://www.atsdr.cdc.gov. Accessed 1/25/09.

(2002 September). Berillyum. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts4.pdf through http://www.atsdr.cdc.gov. Accessed 1/25/09.

(2008 September). Cadmium. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts5.pdf through http://www.atsdr.cdc.gov. Accessed 1/25/09.

(2008 September). Chromium. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts7.pdf through http://www.atsdr.cdc.gov. Accessed 1/25/09.

(2008 May 23). Hexavalent Chromium. OSHA Safety and Health Topics [On-line information]. Available online at http://www.osha.gov/SLTC/hexavalentchromium/index.html through http://www.osha.gov. Accessed 1/25/09.

(2004 April). Cobalt. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts33.pdf through http://www.atsdr.cdc.gov. Accessed 1/25/09.

(2004 September). Copper. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts132.pdf through http://www.atsdr.cdc.gov. Accessed 1/25/09.

(2007 August). Lead. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts13.pdf through http://www.atsdr.cdc.gov. Accessed 1/25/09.

(2008 September). Manganese. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts151.pdf through http://www.atsdr.cdc.gov. Accessed 1/25/09.

(1999 April). Mercury. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts46.pdf through http://www.atsdr.cdc.gov. Accessed 1/25/09.

(2005 August). Nickel. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts15.pdf through http://www.atsdr.cdc.gov. Accessed 1/25/09.

(2003 September). Selenium. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts92.pdf through http://www.atsdr.cdc.gov. Accessed 1/25/09.

(1999 July). Silver. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts146.pdf through http://www.atsdr.cdc.gov. Accessed 1/25/09.

(1995 September). Thallium. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts54.pdf through http://www.atsdr.cdc.gov. Accessed 1/25/09.

(2005 August). Tin and Tin Compounds. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts55.pdf through http://www.atsdr.cdc.gov. Accessed 1/25/09.

(1995 September). Vanadium. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts58.pdf through http://www.atsdr.cdc.gov. Accessed 1/25/09.

(2005 August). Zinc. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts60.pdf through http://www.atsdr.cdc.gov. Accessed 1/25/09.

Podsiki, C. (2008 November). Chart of Heavy Metals, their Salts and Other Compounds. American Institute for Conservation of Historic and Artistic Works [On-line information]. PDF available for download at http://aic.stanford.edu/health/guides/heavy_metals_table_11_08.pdf through http://aic.stanford.edu. Accessed on 1/25/09.

Roth, E. and Quig, D. (2008 May). Toxic Metals, Why Hair Analysis Deserves Another Look. Clinical Laboratory News v 34, (5) [On-line information]. Available online at http://www.aacc.org/publications/cln/2008/may/Pages/series_0508.aspx through http://www.aacc.org. Accessed on 1/25/09.

Clarke, W. and Dufour, D. R., Editors (© 2006). Contemporary Practice in Clinical Chemistry: AACC Press, Washington, DC. P. 474.

Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Burtis CA, Ashwood ER and Bruns DE, eds. 4th ed. St. Louis, Missouri: Elsevier Saunders; 2006, Pp. 1371-1374.

Harrison's Principles of Internal Medicine. 16th ed. Kasper D, Braunwald E, Fauci A, Hauser S, Longo D, Jameson JL, eds. McGraw-Hill, 2005, Pp. 2577-2580.

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