These results are from a real test done May 31, 2019. Patient was a 59 year old female.
Personal information removed to protect patients privacy.
LAB #: U1###1-2###-1
CLIENT #: #####
### ### #######
24 Hour Urine Test
pH upon receipt:
less than detection limit
Creatinine by Jaffe Method
Results are creatinine corrected to account for urine dilution variations. Reference intervals and corresponding graphs
are representative of a healthy population under non-provoked conditions. Chelation (provocation) agents can
increase urinary excretion of metals/elements.
©DOCTOR’S DATA, INC. y
yyy ADDRESS: 3755 Illinois Avenue, St. Charles, IL 60174-2420 yyyy LAB DIR: Erlo Roth, MD yyyy CLIA ID NO: 14D0646470
This analysis of urinary elements was performed by ICP-Mass Spectroscopy following acid
digestion of the specimen. Urine element analysis is intended primarily for: diagnostic
assessment of toxic element status, monitoring detoxification therapy, and identifying or
quantifying renal wasting conditions. It is difficult and problematic to use urinary elements
analysis to assess nutritional status or adequacy for essential elements. Blood, cell, and
other elemental assimilation and retention parameters are better indicators of nutritional
1) 24 Hour Collections
”Essential and other” elements are reported as mg/24 h; mg element/urine volume (L) is
equivalent to ppm. ”Potentially Toxic Elements” are reported as µg/24 h; µg element/urine
volume (L) is equivalent to ppb.
2) Timed Samples (< 24 hour collections)
All ”Potentially Toxic Elements” are reported as µg/g creatinine; all other elements are
reported as µg/mg creatinine. Normalization per creatinine reduces the potentially
great margin of error which can be introduced by variation in the sample volume. It
should be noted, however, that creatinine excretion can vary significantly within an
individual over the course of a day.
If one intends to utilize urinary elements analysis to assess nutritional status or renal
wasting of essential elements, it is recommended that unprovoked urine samples be
collected for a complete 24 hour period. For provocation (challenge) tests for potentially
toxic elements, shorter timed collections can be utilized, based upon the
pharmacokinetics of the specific chelating agent. When using EDTA, DMPS or DMSA,
urine collections up to 12 hours are sufficient to recover greater than 90% of the
mobilized metals. Specifically, we recommend collection times of: 9 – 12 hours post
intravenous EDTA, 6 hours post intravenous or oral DMPS and, 6 hours post oral
bolus administration of DMSA. What ever collection time is selected by the physician, it
is important to maintain consistency for subsequent testing for a given patient.
If an essential element is sufficiently abnormal per urine measurement, a descriptive text
is included with the report. Because renal excretion is a minor route of excretion for
some elements, (Cu, Fe, Mn Zn), urinary excretion may not influence or reflect body
stores. Also, renal excretion for many elements reflects homeostasis and the loss of
quantities that may be at higher dietary levels than is needed temporarily. For these
reasons, descriptive texts are provided for specific elements when deviations are
clinically significant. For potentially toxic elements, a descriptive text is provided
whenever levels are measured to be higher than expected. If no descriptive texts follow
this introduction, then all essential element levels are within acceptable range and all
potentially toxic elements are within expected limits.
Reference intervals and corresponding graphs shown in this report are representative of a
healthy population under non-provoked conditions. Descriptive texts appear in this report
on the basis of measured results and correspond to non-challenge, non-provoked conditions.
Chelation (provocation) agents can increase urinary excretion of metals/elements. Provoked
1999–2019 Doctor’s Data, Inc.
Heavy Metals Urine Test
reference intervals have not been established therefore non-provoked reference intervals shown
are not recommended for comparison purposes with provoked test results. Provoked results can be
compared with non-provoked results (not reference intervals) to assess body burden of metals
and to distinguish between transient exposure and net retention of metals. Provoked results can
also be compared to previous provoked results to monitor therapies implemented by the treating
physician. Additionally, Ca-EDTA provoked results can be used to calculate the EDTA/Lead
Excretion Ratio (LER) in patients with elevated blood levels.
CAUTION: Even the most sensitive instruments have some detection limit below which
a measurement cannot be made reliably. Any value below the method detection limit is
simply reported as ”< dl.” If an individual excretes an abnormally high volume of urine,
urinary components are likely to be extremely dilute. It is possible for an individual to
excrete a relatively large amount of an element per day that is so diluted by the large
urine volume that the value measured is near the dl. This cannot automatically be
assumed to be within the reference range.
Barium (Ba) has not been established to be an essential element. Elevated levels of
Ba often are observed after exposure to Ba (a contrast agent) during diagnostic medical
tests (e.g. ”barium swallow”, ”upper GI series”, ”barium enema”, etc.). Elevated levels of
Ba may interfere with calcium metabolism and potassium retention. Acutely high intake
of soluble Ba-salts (nitrates, sulfides, chlorides) can be toxic. Chronic exposure to Ba
may be manifested by muscular and myocardial stimulation, tingling in the extremities,
and loss of tendon reflexes.
Brazil nuts and peanuts/peanut butter are very high in Ba so urine Ba may be elevated
shortly after consumption of these foods; toxic effects would not be anticipated under such
conditions. Although Ba is poorly absorbed orally (<5%) it can be very high in peanuts and
peanut butter (about 3,000 nanograms/gram), frozen and fast foods such as burgers, fries,
and hot dogs (400-500 nanograms/gram). It is noteworthy that Ba intake is much higher in
children than adults (Health Canada 2005, www.atsdr.cdc.gov/toxprofiles/tp24-c6.pdf).
Ba is surprisingly abundant in the Earth’s crust, being the 14th most abundant element.
High amounts of Ba may be found in soils and in food, such as nuts (e.g. brazil nuts),
seaweed, fish and certain plants. Because of the extensive use of barium in industry, human
activitiesadd greatly to the release of barium in the environment. As a result barium concen-
trations in air, water and soil may be higher than naturally occurring concentrations in many
locations. It can also enter the air during coal and oil combustion. Barium compounds are used
by the oil and gas industries to make drilling mud. Drilling mud simplifies drilling through rocks
by lubricating the drill. Barium compounds are also used to make paint, brics, tiles, glass, and
rubber. Soluble Ba compounds are highly toxic and may be used as insecticides. Ba-aluminates
are utilized for water purification, acceleration of concrete solidification, production of synthetic
zeolites, and in the paper and enamel industries.
Ba levels (and the levels of 16 other elements) in water can be assessed with water testing
as provided by DDI. A possible confirmatory test for excessive Ba is measurement of blood
electrolytes as hypokalemia may be associated with excessive Ba in the body. Hair elements
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analysis may provide further evidence of exosure to Ba.
This individual’s urine thallium (Tl) is higher than expected, but associated symptoms or toxic
effects may or may not be presented. Presentation of symptoms can depend upon several factors
including: chemical form of the Tl, mode of assimilation, severity and duration of exposure, and
organ levels of metabolites and nutrients that effect the action of Tl in the body.
Thallium can be assimilated transdermally, by inhalation, or by oral ingestion. Both valence
states can have harmful effects: Tl+1 may displace potassium from binding sites and influences
enzyme activities; Tl+3 affects RNA and protein synthesis. Tl is rapidly cleared from blood and is
readily taken up by tissues. It can be deposited in kidneys, pancreas, spleen, liver, lungs, muscles,
neurons and the brain. Blood is not a reliable indicator of Tl exposure.
Symptoms that may be associated with excessive Tl exposure are often delayed. Early signs
of chronic, low-level Tl exposure and retention may include: mental confusion, fatigue, and peripheral
neurological signs: paresthesias, myalgias, tremor and ataxia. After 3 to 4 weeks, diffuse hair loss
with sparing of pubic and body hair and a lateral fraction of eye- brows usually occurs. Increased
salivation occurs less commonly. Longer term or residual symptoms may include: alopecia, ataxia,
tremor, memory loss, weight loss, proteinuria (albuminuria), and possibly psychoses. Ophthalmologic
neuritis and strabismus may be presented.
Environmental and occupational sources of Tl include: contaminated drinking water,
airborne plumes or waste streams from lead and zinc smelting, photoelectric, electrochemical and
electronic components (photoelectric cells, semiconductors, infrared detectors, switches),
pigments and paints, colored glass and synthetic gem manufacture, and industrial catalysts used
in some polymer chemistry processes. Thallium is present in some ”weight loss” supplements
(e.g. Active 8) at undisclosed levels (”trade secret”).
Hair (pubic or scalp) element analysis may be used to test for suspected Tl exposure.
Although urine is the primary natural route for excretion of thallium, the biliary/fecal route also
contributes. Therefore, fecal metals analysis provides a confirmatory test for chronic ongoing
exposure to Tl. Clinical findings that might be associated with excessive Tl are: albuminuria,
EEG with diffuse abnormalities, hypertension, and elevated urine creatinine phosphokinase (CPK).
No provocation agents are currently available to estimate Tl retention by means of urinalysis.
BIBLIOGRAPHY FOR THALLIUM
1. Centers for Disease C ontrol and Prevention. Third National Report on Human Exposure
to Environmental Chemicals. Atlanta, GA: CDC 2005. http;//www.cdc.gov/exposurereport.htm
2. Graef J.W. ”Thallium” in Harrison’s Principles of Internal Medicine, 13th ed., Isselbacher et al
eds., McGraw Hill, pp 2465, 1994.
3. Tsalev D.L. and Zaprianov Z.K. Atomic Absorption Spectrometry in Occupational and
Environmental Health Practice CRC Press, Boca Raton FL, pp 196-199, 1983.
4. Carson B.L. et al. Toxicology and Biological Monitoring of Metals in Humans Lewis Publishers,
Chelsea, MI, pp 243-254, 1987.
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1999–2019 Doctor’s Data, Inc.