Lead Urine Test

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Actual test done February 22, 2020 by 48 year old female.

Lead Urine Test
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LAB #: ###-####-##
PATIENT:
 ##### ####
ID:
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SEX:
 Female
DOB:
 ##/##/1971

AGE: 48

CLIENT #: #####
DOCTOR:
 ##### #######

## ###### ##### ###
#### ######## ## ##### ###

Lead Urine Test

TOXIC METALS

RESULT

REFERENCE

WITHIN 

µ

g/g creat

INTERVAL

REFERENCE

  

OUTSIDE REFERENCE

Aluminum

(Al)

9.4

<     35

Antimony

(Sb)

< dl

<    0.2

Arsenic

(As)

6.1

<     80

Barium

(Ba)

5.8

<      7

Beryllium

(Be)

< dl

<      1

Bismuth

(Bi)

4.3

<      4

Cadmium

(Cd)

0.4

<      1

Cesium

(Cs)

8.3

<     10

Gadolinium

(Gd)

0.4

<    0.8

Lead

(Pb)

6.3

<      2

Mercury

(Hg)

2.5

<      4

Nickel

(Ni)

1.1

<     10

Palladium

(Pd)

< dl

<    0.3

Platinum

(Pt)

< dl

<    0.1

Tellurium

(Te)

< dl

<    0.5

Thallium

(Tl)

0.4

<    0.5

Thorium

(Th)

< dl

<   0.03

Tin

(Sn)

0.7

<      5

Tungsten

(W)

0.09

<    0.4

Uranium

(U)

< dl

<   0.04

URINE CREATININE

RESULT

REFERENCE

mg/dL

INTERVAL

        -2SD      -1SD

MEAN

        +1SD   +2SD

Creatinine

37.7

    30-   225

SPECIMEN DATA

Comments:

    

Date Collected:

02/22/2020

pH upon receipt:

  

Acceptable

Collection Period:

timed: 6 hours

Date Received:

02/27/2020

<dl:

less than detection limit

Volume:

 

Date Reported:

02/28/2020

Provoking Agent:

 

DMSA 1500MG

Provocation:

 

POST PROVOCATIVE

Method:

ICP-MS

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. 

V13

©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

0001523


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                                                                     INTRODUCTION

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 
status.

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 

 19992020  Doctor’s Data, Inc.


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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.

                                                                    BISMUTH HIGH 
 
     This individual’s urine bismuth is higher than expected. Urine is the principal mode for 
excretion of absorbed bismuth. This element is considered to be only slightly toxic with ingestion 
of gram quantities necessary before signs of toxicity occur. Only between 5 and 10% of orally 
ingested, soluble bismuth salts are absorbed into the blood. 
 
     Bismuth is a byproduct of lead and copper ore refining. Bismuth has therapeutic uses with 
antimicrobial, anti-secretory and anti-inflammatory actions. Bismuth subsalicylate (”Pepto-Bismol”) 
hydrolyzes in the stomach to salicylic acid and insoluble bismuth; it can be effective in halting 
traveler’s diarrhea. Historically, bismuth was used to treat syphilis. Bismuth is used commercially 
in low-melting-point alloys and solders and is commonly in ”automatic” sprinkler heads for in-
building fire protection. Bismuth often is a component of: pigments, paints, glazes for ceramics,
glass, and some semiconductor materials. Some cosmetics including lipstick may contain bismuth 
oxides as a pigment (pearlescent white). Dry cell battery electrodes (cathode) may contain 
bismuth. 
 
     At sub-gram quantities, no toxic effects are documented for bismuth. Also, the existence of 
health problems due to environmental pollution by bismuth is not documented (Tsalev p. 101, 
1983). Early physiological signs of bismuth excess may include: constipation or bowel irregularity, 
foul breath, skin pigmentation changes, and gum pigmentation (blue-black) with stomatitis.  
 
     Laboratory tests that help to assess bismuth status are whole blood and hair element 
analyses. Some increase in urine bismuth may follow administration of dithiol chelators (DMPS,
DMSA).  Bismuth has a very high affinity for sulfhydryl groups. 

 BIBLIOGRAPHY FOR BISMUTH 
 1. Harrison’s Principles of Internal Medicine, 13th ed, McGraw Hill, New York, NY pp. 282, 534, 
1994. 
 2. Tsalev D.L. and Z.K. Zaprianov Atomic Absorption Spectrometry in Occupational and 
Environmental Health Practice CRC Press, Boca Raton FL, pp 101-103, 1983. 
 3. Carson B.L. et al. Toxicology and Biological Monitoring of Metals in Humans Lewis Publishers, 

 19992020  Doctor’s Data, Inc.


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Chelsea MI pp 44-7, 1987. 

                                                                      LEAD HIGH

     This individual’s urine lead exceeds three times the upper expected limit per the 
reference population. Because a percentage of absorbed or assimilated lead is excreted 
in urine, the urine lead level reflects  recent or ongoing exposure to lead and the degree 
of excretion or detoxification.

     Sources of lead include: old lead-pigment paints, batteries, industrial smelting and 
alloying, some types of solders, ayruvedic herbs, some toys and products from China, 
glazes on (foreign) ceramics, leaded (antiknock compound) fuels, bullets and fishing 
sinkers, artist paints with lead pigments, and leaded joints in some municipal water 
systems. Most lead contamination occurs via oral ingestion of contaminated food or water 
or by children mouthing or eating lead-containing substances. The degree of absorption of 
oral lead depends upon stomach contents (empty stomach increases uptake) and upon 
the body’s mineral status. Deficiency of zinc, calcium or iron may increase lead uptake. 
Transdermal exposure is slight. Inhalation has decreased significantly with almost universal 
use of non-leaded automobile fuel.

     Lead accumulates extensively in bone and inhibits formation of heme and hemoglobin in 
erythroid precursor cells. Bone lead is released to soft tissues with bone remodeling that can 
be accelerated with growth, menopausal hormonal changes and osteoporosis. Lead has 
physiological and pathological effects on body tissues that may be manifested from relatively low 
lead levels up to acutely toxic levels. In children, developmental disorders and behavior problems 
may occur at relatively low levels: loss of IQ, hearing loss, poor growth. In order of occurrence 
with increasing lead concentration, the following can occur: impaired vitamin D metabolism, 
initial effects on erythrocyte and erythroid precursor cell enzymology, increased erythrocyte 
protoporphyrin, headache, decreased nerve conduction velocity, metallic taste, loss of appetite, 
constipation, poor hemoglobin synthesis, colic, frank anemia, tremors, nephrotoxic effects with 
impaired renal excretion of uric acid, neuropathy and encephalopathy. At relatively low levels, 
lead can participate in synergistic toxicity with other toxic elements (e.g. cadmium, mercury).

     Excessive retention of lead can be assessed by urinalysis after provocation with Ca-EDTA (iv) 
or oral DMSA. Whole blood analysis can be expected to reflect onlyrecent exposures and does 
not correlate well with total body burden of lead. 

BIBLIOGRAPHY FOR LEAD

1.ATSDR Toxicological Profile for Lead( 2007 update) www.atsdr.cdc.gov/toxprofile 

2. Lead Tech ’92, ”Proceedings and Papers from the Lead Tech ’92: Solutions for a Nation at Risk” 
Conference, Sept 30-Oct 2, 1992. Bethesda, MD, IAQ Publications, 4520 East-West Highway, 
Ste 610, Bethesda, MD, 20814.

3. ”Preventing Lead Poisoning in Young Children”, US Centers for Disease Control, Atlanta, GA, 
Oct. 1991 Statement, US Dept. of Health and Human Services.

4. Carson B.L. et al. Toxicology and Biological Monitoring of Metals in Humans, Lewis Publishers, 
Inc., Chelsea, MI, p. 128-135, 1986.

 19992020  Doctor’s Data, Inc.


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5. Tsalev D.L. et al. Atomic Absorption Spectrometry in Occupational and Environmental Health 
Practice Vol 1, CRC Press, BocaRaton, FL 1983.

6. Piomelli S. et al. ”Management of Childhood Lead Poisoning”, J. Pediatr 105 (1990) p. 523-32.

7. Shubert J. et al. ”Combined Effects in Toxicology – a Rapid Systematic Testing Procedure: 
Cadmium, Mercury and Lead” - J. Toxicology and Environmental Health, 4:763-776, 1978.

 19992020  Doctor’s Data, Inc.

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