Heavy Metals & Toxins

Heavy Metals & Toxins, Pediatric Testing

The Centers for Disease Control and Prevention recommends the following testing schedule for children with elevated BLLs (blood lead levels) on a screening test.2See table.Blood Lead Levels (CDC)Blood(μg/dL):Time to Confirmation Testing:*The higher the BLL on the screening test, the more urgent the need for confirmation testing.Reference value-91 to 3 m10−451 w to 1 m*45−5948 h60−6924 h≥70Urgently as emergency test

Heavy Metals & Toxins, Pediatric Testing

The Centers for Disease Control and Prevention recommends the following testing schedule for children with elevated BLLs (blood lead levels) on a screening test.2See table.Blood Lead Levels (CDC)Blood(μg/dL):Time to Confirmation Testing:*The higher the BLL on the screening test, the more urgent the need for confirmation testing.Reference value-91 to 3 m10−451 wk to 1 m*45−5948 h60−6924 h≥70Urgently as emergency test

Heavy Metals & Toxins

Hematologic consequences ascribed to lead toxicity may be basophilic stippling, mild anemia, and reticulocytosis. Other characteristics of toxicity may include increased urine δ-aminolevulinic acid, increased erythrocyte protoporphyrins, and decreased aminolevulinic acid dehydrase. Lead lines on gums or at the metaphyses of long bones in children may also be present.2Early symptoms of lead poisoning include anorexia, apathy or irritability, fatigue, and anemia.3Toxic effects include GI distress, joint pain, colic, headache, stupor, convulsions, and coma.Lead and organic lead compounds have numerous commercial and industrial applications, including paints, plastics, storage batteries, bearing alloys, insecticides, and ceramics. Exposure may also occur through the inhalation of dust containing lead emitted by automobile exhaust. A common source of lead exposure among children is through the mouthing of inanimate objects, specifically objects with paint and paint chips that contain lead. Acute lead exposure is rare; however, toxicity may occur through acute ingestion of a lead salt or acetate. Blood is the preferred specimen by which the extent of an acute or recent exposure to lead may be measured.BEI® are reference values intended as guidelines for evaluation of occupational exposure. BEI® represent biological levels of chemicals that correspond to workers with inhalation exposure equivalent to the threshold limit value (TLV®) of the chemicals. TLVs refer to the airborne concentrations of substances and represent conditions under which it is believed that nearly all workers may be repeatedly exposed, day after day, without adverse health effects.1

Heavy Metals & Toxins

High serum osmolalitycan result from hypernatremia, dehydration, hyperglycemia, mannitol therapy, azotemia, ingestion of ethanol, methanol, ethylene glycol. Thus, osmolality has a role in toxicology and in coma evaluation. Elevated serum osmolality with normal sodium suggests possible hyperglycemia, uremia, or alcoholism.1Low serum osmolalitymay be secondary to overhydration, hyponatremia, syndrome of inappropriate antidiuretic hormone secretion (SIADH) with carcinoma of lung and other entities.

Heavy Metals & Toxins

Blood lead level analysis is performed to evaluate the body burden of lead.

Nutrition & Vitamins, Heavy Metals & Toxins

The demand for sensitive noninvasive tests for Wilson's disease, especially for children in families where the disease is known to occur, has stimulated search for newer indices of copper metabolism. Urine copper after penicillamine load has recently been proposed.5

Heavy Metals & Toxins

Blood lead level analysis is performed to evaluate the body burden of lead.

Allergy Testing, Heavy Metals & Toxins

Stachybotrys chartarum/atrais a mold that has been implicated in a variety of illnesses associated with water-damaged buildings.Stachybotrysrequires cellulose as a growth substrate and is usually found on building materials composed of cellulose (e.g. ceiling tiles and wallboards).Individuals who respond to exposure to mold antigens by producing specific IgE may exhibit allergy symptoms when subsequently re-exposed to spores from mold.

Heavy Metals & Toxins

Aluminum toxicity has been recognized in many settings where exposure is heavy or prolonged, where renal function is limited, or where a previously accumulated bone burden is released in stress or illness. Toxicity may include:• Encephalopathy (stuttering, gait disturbance, myoclonic jerks, seizures, coma, abnormal EEG)• Osteomalacia or aplastic bone disease (associated with painful spontaneous fractures, hypercalcemia, tumorous calcinosis)• Proximal myopathy• Increased risk of infection• Increased left ventricular mass and decreased myocardial function• Microcytic anemia• With very high levels, sudden deathAluminum is ubiquitous in our environment; it is the third most prevalent element in the earth's crust. The gastrointestinal tract is relatively impervious to aluminum, absorption normally being only about 2%. Aluminum is absorbed by a mechanism related to that for calcium. Gastric acidity and oral citrate favors absorption, and H2-blockers reduce absorption. As is true for several trace elements, transferrin is the primary protein binder and carrier for aluminum in the plasma, where 80% is protein bound and 20% is free or complexed to small molecules such as citrate. Cells appear to take up aluminum from transferrin rather than from citrate. Purified preparations of ferritin from brain and liver have been found to contain aluminum. It is not known if ferritin has a specific binding site for aluminum. Factors regulating the migration of aluminum across the blood-brain barrier are not well understood. Serum aluminum correlates with encephalopathy; red cell aluminum correlates with microcytic anemia;1and bone aluminum correlates with aluminum bone disease. Basal PTH when elevated appears to protect bone and thereby favor CNS toxicity. Other factors favoring one form of toxicity over another are not well understood. Aluminum toxicity has been reported to impair the formation and release of parathyroid hormone. The parathyroid glands concentrate aluminum above levels in surrounding tissues. Treatment of aluminum toxicity in renal failure patients often reactivates hyperparathyroidism, which to a certain extent is helpful for bone remodeling and healing.

Heavy Metals & Toxins

Carboxyhemoglobin is useful in judging the extent of carbon monoxide toxicity and in considering the effect of smoking on the patient. A direct correlation has been claimed between CO level and symptoms of atherosclerotic diseases, intermittent claudication, angina, and myocardial infarction. Exposure may occur not only from smoking but also from garage exposure, and from various motors. This test may be included when blood gases are ordered, when there is sufficient sample, and when such instrumentation is available.A danger of missed diagnosis of CO intoxication is continued exposure of the patient and others to a toxic environment.3The cherry red color of CO poisoning is not consistently seen.4CO intoxication may contribute to the risk of myocardial infarction.4,5A strong correlation is present between carboxyhemoglobin levels and psychometric testing abnormalities.2Psychometric testing measures actual neurologic disability and may therefore better define carboxyhemoglobin poisoning severity than blood CO level.

Heavy Metals & Toxins

Carbon monoxide is the most common of the gaseous poisons. Malfunctioning or poorly ventilated heating appliances and internal combustion engines are frequent causes of carbon monoxide poisoning. Carbon monoxide combines reversibly with hemoglobin in a manner almost identical to oxygen resulting in a decrease in the amount of oxygen carried by hemoglobin. Accidental poisoning can occur even at low levels (greater than 0.01%) of CO in the atmosphere with prolonged exposure.

Heavy Metals & Toxins

Diagnostic information:Exposure to isocyanates may cause chemical bronchitis with initial symptoms of throat irritation, laryngitis, coughing, and chest pain or tightness.1Asthma (with symptoms of wheezing, coughing, and shortness of breath) may also follow exposure to isocyanates.1Other effects associated with isocyanate exposure are hypersensitive pneumonitis, chronic pulmonary disease, and contact dermatitis (following direct skin contact).1Clinical significance:Between 2% and 15% of all asthma associated with industry attributed to occupational exposure to chemicals.2Quantitative allergen-specific IgE testing offers the capability of monitoring workplace exposure to isocyanates through the measurement of acid isocyanate-specific IgE levels. Increases in acid specific IgE levels are correlated with elevations in exposure.1Sources of exposure:TDI, MDI, and HDI are three of the most frequently used isocyanates in industry.3The isocyanates are used primarily as starting materials for a variety of manufacturing processes, including the production of plastics, polyurethane, foams, and electrical wire insulation.1Isocyanates are also common components of paints and other durable and protective finishes, adhesives, and elastomers in automobile bumpers, printing rolls, and coated fabrics.1Exposure can occur at any stage from the initial manufacturer of the isocyanates to their final use in various production processes.1Exposure can also occur from the application of paints and polyurethanes, from the handling and machining of foams, and from the combustion of these materials.1

Heavy Metals & Toxins

Offered as part of multiple lab tests

Heavy Metals & Toxins, Nutrition & Vitamins

Offered as part of multiple lab tests

Heavy Metals & Toxins, Nutrition & Vitamins

Chromium exposure through the inhalation of insoluble chromium compounds may produce pneumoconiosis with impairment of pulmonary function. Exposure to the inorganic soluble salts can precipitate skin ulcerations, dermatitis, perforation of the nasal septum, and respiratory sensitization. Acute exposure to these salts may result in local tissue necrosis and severe kidney damage.2Chromium and its inorganic salts are widely employed in industry, including metal plating, steel and nonferrous alloys, refractory materials, and chromate pigments and preservatives. In organic forms, chromium is also an essential nutrient for man supplied in the diet (5−115 μg/day); however, overexposure is generally associated with the industrial environment, specifically through the inhalation of chromium dust and fumes.BEI® are reference values intended as guidelines for evaluation of occupational exposure. BEI® represent biological levels of chemicals that correspond to workers with inhalation exposure equivalent to the threshold limit value (TLV®) of the chemicals. TLVs refer to the airborne concentrations of substances and represent conditions under which it is believed that nearly all workers may be repeatedly exposed, day after day, without adverse health effects.3

Heavy Metals & Toxins

Offered as part of multiple lab tests

Heavy Metals & Toxins

Individuals undergoing hemodialysis are at risk for aluminum toxicity. Prolonged accumulation may cause anemia, encephalopathy, and vitamin D-resistant osteomalacia. Also, workers exposed to high levels or to long-term low levels of aluminum dust are at increased risk of toxicity.

Heavy Metals & Toxins

Blood levels of arsenic have a short half-life and are useful only for monitoring recent or acute exposure. Urine arsenic measurement is a better measure of arsenic poisoning. In addition to pesticides, rodenticides, weed killers, paint, and wood preservatives contain arsenic.

Heavy Metals & Toxins, Nutrition & Vitamins

Cobalt poisoning through chronic exposure may result in pulmonary fibrosis, cough, and dyspnea. Acute exposures are generally characterized by an allergic dermatitis.2Cobalt is employed industrially in certain grades of steel and in tungsten carbide tools, and cobalt compounds are used as pigments in paints. In addition, cobalt is an essential element in man, supplied through dietary intake at an average of 280 μg/day. Although cobalt is found in the general environment, overexposure typically occurs in the industrial environment, primarily through the inhalation of cobalt dust and/or fumes. Cobalt exposure can also occur as a result of ingesting medications such as cobaltous chloride. Blood is the preferred specimen for measuring acute or recent exposure.

Heavy Metals & Toxins

Copper poisoning through chronic inhalation of copper fumes and/or dusts that are typically associated with industry may produce symptoms of nausea, vomiting, nervous manifestations, and hepatomegaly. Acute exposures through inhalation can cause typical metal-fume fever, chills, upper respiratory irritation, and aching muscles. Elevated urine copper levels may also occur with biliary cirrhosis, chronic active hepatitis, or Wilson disease.2Copper poisoning through chronic exposure is rare in the general population, excepting individuals with Wilson's disease. Overexposure to copper is generally associated with industry through the inhalation of copper dust and/or fumes that arise in operations involving copper (eg, metallurgy, copper plating, soldering). Acute ingestion is a viable concern for the general population and can be precipitated by food contamination from copper utensils or the accidental or intentional ingestion of copper salts.

Heavy Metals & Toxins

This assay is used to monitor exposure to arsenic, wellness, and therapy during treatment of chronic myelocytic leukemia.

Nutrition & Vitamins, Heavy Metals & Toxins

Copper is an essential element that is a cofactor of many enzymes. Copper metabolism is disturbed in Wilson's disease, Menkes disease, primary biliary cirrhosis, and Indian childhood cirrhosis. Urinary copper concentrations are also useful to monitor patients on chealation therapy.

Heavy Metals & Toxins

Cobalt is part of our diet. Approximately 85% of absorbed cobalt is excreted in the urine and the remainder eliminated in stool. Toxicity may occur in select industrial environments. Cobalt is not mined in the United States so primary supplies are imported.

Heavy Metals & Toxins, Nutrition & Vitamins

Offered as part of multiple lab tests

Heavy Metals & Toxins

Occupational exposure and exposure to environmental contamination of chromium may lead to toxicity. The need for chromium supplements is unproven. Supplements taken in excess can lead to toxicity.

Heavy Metals & Toxins

Mercury, a highly toxic metal, is present in select industrial environments and in contaminated ocean fish. Urinary measurements are appropriate for assessing ongoing exposure to inorganic mercury.

Heavy Metals & Toxins, Nutrition & Vitamins

Zinc protoporphyrin (ZPP) accumulates in erythrocytes as a result of chronic lead absorption or iron deficiency anemia.

Heavy Metals & Toxins, Nutrition & Vitamins

Mercury, a highly toxic metal, is present in select industrial environments and in contaminated ocean fish.

Heavy Metals & Toxins, Nutrition & Vitamins

Offered as part of multiple lab tests

Heavy Metals & Toxins

Cadmium poisoning through industrial exposure to inorganic cadmium fumes may produce fatigue, coughing, chest pain, a burning sensation in the throat, and renal damage. The prognosis of persons with cadmium-induced renal dysfunction is unfavorable, with urinary β-microglobulin and urinary protein the most important factors.2Inhalation of cadmium fumes can lead to pneumonia with acute exposure and emphysema with chronic exposure.3Cadmium poisoning is predominantly associated with cadmium fumes and/or inorganic cadmium salts that may be present in certain industrial environments. Cadmium and its inorganic compounds are commonly found in industry. Cadmium is utilized in many alloys and metal plating. Inorganic cadmium fumes or dusts are generally associated with heating, welding, and grinding of cadmium-containing metal products. Cadmium exposure in the general populace is derived from dietary intake, averaging 2−200 μg/day, and is only occasionally the precipitant of overexposure.In organic forms, cadmium is present in food, water, and air. The normal daily intake of organic forms of cadmium ranges from 2−200 μg. Although this soluble form of cadmium may produce toxicity, overexposure to organic cadmium is generally indicative of isolated, environmental pollution. Whole blood is the recommended specimen for measuring acute or recent exposure.BEI® are reference values intended as guidelines for evaluation of occupational exposure. BEI® represent biological levels of chemicals that correspond to workers with inhalation exposure equivalent to the threshold limit value (TLV®) of the chemicals. TLVs refer to the airborne concentrations of substances and represent conditions under which it is believed that nearly all workers may be repeatedly exposed, day after day, without adverse health effects.1

Heavy Metals & Toxins

Cadmium is a naturally occurring element that is mined and used in industrial production because of its durability. Excessive cadmium exposure can damage lungs, kidneys, and the digestive tract.

Heavy Metals & Toxins

Copper poisoning through chronic inhalation of copper fumes and/or dusts that are typically associated with industry may produce symptoms of nausea, vomiting, nervous manifestations, and hepatomegaly. Acute exposures through inhalation can cause typical metal-fume fever, chills, upper respiratory irritation, and aching muscles. Elevated urine copper levels may also occur with biliary cirrhosis, chronic active hepatitis, or Wilson disease.2Copper poisoning through chronic exposure is rare in the general population, excepting individuals with Wilson's disease. Overexposure to copper is generally associated with industry through the inhalation of copper dust and/or fumes that arise in operations involving copper (eg, metallurgy, copper plating, soldering). Acute ingestion is a viable concern for the general population and can be precipitated by food contamination from copper utensils or the accidental or intentional ingestion of copper salts.

Heavy Metals & Toxins

Copper is an essential element that is a cofactor of many enzymes. Copper metabolism is disturbed in Wilson's disease, Menkes disease, primary biliary cirrhosis, and Indian childhood cirrhosis. Urinary copper concentrations are also useful to monitor patients on chelation therapy.

Heavy Metals & Toxins

See individual tests.

Heavy Metals & Toxins

Offered as part of multiple lab tests

Heavy Metals & Toxins

Arsenic is widely distributed in the earth's crust. Arsenic is used in some pesticides and industrial applications. Arsenic toxicity can cause skin changes, respiratory illness, nausea and vomiting, and other effects.

Heavy Metals & Toxins

Cadmium is a naturally occurring element that is mined and used in industrial production because of its durability. Excessive cadmium exposure can damage lungs, kidneys, and the digestive tract.

Heavy Metals & Toxins

The incubation period for COVID-19 ranges from 5 to 7 days. Current literature suggests that detectable IgG-class antibodies against SARS-CoV-2 develop approximately 8 to 11 days following onset of symptoms. Correlation with epidemiologic risk factors and other clinical and laboratory findings is recommended. A positive serological result is not diagnostic but indicates that an individual has likely been infected with SARS-CoV-2 and produced an immune response to the virus. It is not known at this time whether detectable antibody correlates with immunity. A negative serologic result indicates that an individual has not developed detectable antibodies at the time of testing. While contingent on a variety of factors, this could be due to testing too early in the course of infection, the absence of exposure to the virus, or the lack of adequate immune response, which can be due to conditions or treatments that suppress immune function.∗FDA-authorized Fact sheets for patients and providers can be accessed at the following link:https://www.fda.gov/medical-devices/emergency-situations-medical-devices/emergency-use-authorizations#covid19ivd

Nutrition & Vitamins, Heavy Metals & Toxins

Selenium toxicity may occur due to industrial exposures or through drinking water in some parts of the world. Toxic symptoms include garlic breath odor, thick brittle fingernails, dry brittle hair, red swollen skin of the hands and feet, and nervous system abnormalities of numbness, convulsions, or paralysis.1Selenium is produced as a byproduct of copper refining and is used in electronic semiconductors, as a decolorizing agent for ceramics and glass, and as a vulcanizing agent in the rubber industry. The essential nature of selenium in human nutrition is now beyond dispute. Multiple cases of selenium deficiency have been reported in patients receiving parenteral nutrition for longer than one week when no selenium was included in their formula. Deficiency has also been reported in severe malnutrition without parenteral nutrition. The syndrome has included painful weak muscles and acute or chronic congestive heart failure due to cardiomyopathy that is sometimes fatal. Other findings noted in some cases of selenium deficiency include erythrocyte macrocytosis, depigmentation of skin and hair, and elevated transaminase and creatine kinase levels.

Heavy Metals & Toxins

For the evaluation of fluid and electrolyte balance.

Heavy Metals & Toxins

Offered as part of multiple lab tests

Heavy Metals & Toxins

Offered as part of multiple lab tests

Heavy Metals & Toxins

Offered as part of multiple lab tests

Heavy Metals & Toxins

Offered as part of multiple lab tests

Nutrition & Vitamins, Heavy Metals & Toxins

Zinc is an essential element involved in a myriad of enzyme systems including wound healing, immune function, and fetal development. Zinc measurements are used to detect and monitor industrial, dietary, and accidental exposure to zinc. Also, Zinc measurements may be used to evaluate health and monitor response to treatment.

Heavy Metals & Toxins

Offered as part of multiple lab tests

Heavy Metals & Toxins

Exposure monitoring/investigation.

Heavy Metals & Toxins

Offered as part of multiple lab tests

Heavy Metals & Toxins

Manganese deficiency produces growth disorders, alters skeletal and cartilage formation and impairs reproduction. Industrial workers absorb manganese mainly through the lungs.

Heavy Metals & Toxins

Useful in the diagnosis of toxicity due to Arsenic, Lead or Mercury.

Heavy Metals & Toxins

Exposure monitoring/investigation.

Heavy Metals & Toxins

Toxic exposure may occur from dry cells, fungicide (maneb), and in the steel or chemical industries. Manganese is present in the coloring agents for glass and soap, in paints, varnish and enamel, and in linoleum. It is used in the manufacture of chlorine gas and in lead-free gasoline. Industrial manganese poisoning has been recognized since 1837.

Heavy Metals & Toxins

See individual tests.

Heavy Metals & Toxins

Excessive exposure to heavy metals can cause acute and chronic toxicity. Heavy Metals Panel is intended to evaluate and monitor exposure to heavy metals and evaluate the process of detoxification.

Heavy Metals & Toxins

This panel is used for monitoring workers for potential exposure to cadmium in the workplace. The beta-2-microglobulin, blood and urine cadmium are integrated to specify the exposure category.

Heavy Metals & Toxins

Offered as part of multiple lab tests

Heavy Metals & Toxins

Offered as part of multiple lab tests

Heavy Metals & Toxins

See individual tests.

Heavy Metals & Toxins

Offered as part of multiple lab tests

Heavy Metals & Toxins

Silicon is environmentally prevalent in that it makes up approximately 25% of the earth's crust. It is used in the manufacturing of transistors, silicon diodes and semiconductors. Symptoms of exposure are most often seen from inhalation of silica dust, which could cause a fibronodular lung disease called silicosis.

Heavy Metals & Toxins

Offered as part of multiple lab tests

Heavy Metals & Toxins, Nutrition & Vitamins

Offered as part of multiple lab tests

Heavy Metals & Toxins

Blood lead level analysis is performed to evaluate the body burden of lead.

Heavy Metals & Toxins

This immunodiffusion assay is highly specific for histoplasmosis infection but may have low sensitivity in early infection. Two different immunoprecipitin bands may be detected. The M band develops with acute infection, is often present in chronic infection, and may persist for months to years. The H band, which is usually present with the M band, generally suggests a chronic or severe acute infection. The presence of both the H and M bands is considered conclusive for the diagnosis of histoplasmosis.

Heavy Metals & Toxins

Offered as part of multiple lab tests

Heavy Metals & Toxins

Offered as part of multiple lab tests