Nickel Urine Test

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Actual test done August 31, 2019 by 72 year old male.

Nickel Urine Test
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ID:
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SEX:
 Male
DOB:
 0#/##/1947

AGE: 72

CLIENT #: #####
DOCTOR:
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Nickel Urine Test

TOXIC METALS

RESULT

REFERENCE

WITHIN 

µ

g/g creat

INTERVAL

REFERENCE

  

OUTSIDE REFERENCE

Aluminum

(Al)

3.5

<     25

Antimony

(Sb)

< dl

<    0.2

Arsenic

(As)

96

<     75

Barium

(Ba)

15

<      7

Beryllium

(Be)

< dl

<      1

Bismuth

(Bi)

0.1

<      2

Cadmium

(Cd)

< dl

<    0.8

Cesium

(Cs)

8.6

<      9

Gadolinium

(Gd)

< dl

<    0.5

Lead

(Pb)

1.2

<      2

Mercury

(Hg)

0.6

<      3

Nickel

(Ni)

9.1

<      8

Palladium

(Pd)

< dl

<    0.3

Platinum

(Pt)

< dl

<    0.1

Tellurium

(Te)

< dl

<    0.5

Thallium

(Tl)

0.2

<    0.5

Thorium

(Th)

< dl

<   0.03

Tin

(Sn)

0.4

<      4

Tungsten

(W)

< dl

<    0.4

Uranium

(U)

< dl

<   0.03

URINE CREATININE

RESULT

REFERENCE

mg/dL

INTERVAL

        -2SD      -1SD

MEAN

        +1SD   +2SD

Creatinine

35.6

    35-   240

SPECIMEN DATA

Comments:

    

Results Checked

Date Collected:

08/31/2019

pH upon receipt:

  

Acceptable

Collection Period:

Random

Date Received:

09/05/2019

<dl:

less than detection limit

Volume:

 

Date Reported:

09/10/2019

Provoking Agent:

 

Provocation:

 

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

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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 

 19992019  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.

                                                                    ARSENIC HIGH 
 
     This inidividual’s urine arsenic (As) is higher than expected. Because urine is the major mode of 
excretion for arsenic, an elevated level reflects increased assimilation of As. Ingestion of organic 
species of As in seafood is not uncommon and may be associated with very elevated urine As. 
Arsenobetaine and arsinocholine, commonly found in shellfish are relatively non-toxic and 90% is 
excreted in the urine with a half-life of about 48 hours.
 
     Sources of As include:  contaminated foods (e.g. chicken), water or medications. Industrial 
sources are:  ore smelting/refining/processing plants, galvanizing, etching plating processes. Tailing 
from or river bottoms near gold mining areas (past or present) may contain arsenic.  Insecticides, 
rodenticides and fungicides (Na-, K- arsenites, arsenates, also oxides are commercially available).  
Commercial As-containing products include: sodium arsenite, calcium arsenate, lead arsenate and 
”Paris green” which is cupric acetoarsenite, a wood preservative (pressure treated wood). Undesirable
 levels of As have been found in many Ayruvedic herbs.
 
     Chronic exposure to or ingestion of inorganic As causes tissue levels to gradually increase as 
the element binds to sulfur, phosphorus and selenium.  An important detrimental effect is inactivation 
of lipoic acid,a vitamin cofactor needed for metabolism of pyruvate and alpha-ketoglutarate. 
 
     Symptoms consistent with mild or moderate As exposure include:  fatigue, malaise, eczema or 
allergic-like dermatitis, and garlic-like breath.  Increased salivation may occur.  Hair element analysis 
may provide further evidence of As exposure to inorganic As. Blood As levels are not dose related and 
may or may not reflect As exposure or net retention of As.  Levels of As may exceed the expected 
range after administration of DMPS or DMSA depending upon cumulative exposures.  This does not 
necessarily indicate As excess to the point of toxic effects or physiological impairment. 

 BIBLIOGRAPHY FOR ARSENIC
1. Centers for Disease Control and Prevention. Third National Report on Human Exposure
to Environmental Chemicals. Atlanta, GA; CDC: 2005.
http://www.cdc.gov/exposurereport/report.htm [Accessed 2/01/2009] 
2. Carson B.L. et al. Toxicology and Biological Monitoring of Metals in Humans, Lewis Publishers, 

 19992019  Doctor’s Data, Inc.


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Chelsea, MI, pp 27-33, 1987. 
3. Tsalev D.L. and Z.K. Zaprianov Atomic Absorption Spectrometry in Occupational and 
Environmental Health Practice, vol. 1, CRC Press, Boca Raton, FL, pp. 87-93, 1983. 
4. Clarkson T.W. et al. eds. Biological Monitoring of Toxic Metals, Plenum Press, NY, NY, pp 
309-15, 1988. 
5. Harrison’s Principles of Internal Medicine, 13th ed., McGraw Hill, New York, NY, pp 2461-62, 
1994. 
6. Heyman A. et al. ”Peripheral Neuropathy Caused by Arsenical Intoxication” New Eng. J. Med., 
254 no.9, pp 401-9 1956. 
7. Saper RB et al. ”lead, mercury and arsenic in U.S.- and Indian-manufactured ayruvedic medicines
sold via the internet.” JAMA(2008) 300(8):915-23.

                                                                     Barium High

     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
analysis may provide further evidence of exosure to Ba.

 19992019  Doctor’s Data, Inc.


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                                                                     NICKEL HIGH 
 
     This individual’s urine nickel (Ni) is elevated which may or may not be of significance. Urinary 
excretion of nickel bound to cysteine or other thiol compounds (such as glutathione) or to amino 
acids (histidine, aspartic acid, arginine) is the predominant mode of excretion. With the exception 
of specific occupational exposures, most absorbed Ni comes from food or drink, and intakes can 
vary by factors exceeding 100 depending upon geographical location, diet, and water supply. 
Depending upon chemical form and physiological factors, from 1 to 10% of dietary Ni may be 
absorbed from the gastrointestinal tract. Urine Ni only reflects recent exposure to Ni and may vary 
widely from day to day.  

 Sources of nickel are numerous and include the following. 
 
     . Cigarettes (2 to 6 mcg Ni per average cigarette) 
     . Diesel exhaust (particulates may contain up to 10 mg/gram) 
     . Foods, especially: cocoa, chocolate, soya products, nuts, 
       hydrogenated oils, and coffee
     . Nickel-cadmium batteries (Ni-Cd)
     . Nonprecious, semiprecious dental materials 
     . Nickel-containing prostheses 
     . Electroplating, metal plated objects, costume jewelry 
     . Pigments (usually for ceramics or glass) 
     . Catalyst materials (for hydrogenation processes in the food, 
       petroleum and petrochemical industries) 
     . Arc welding 
     . Nickel refining and metallurgical processes  
 
     Most clinically relavant Ni exposures are manifested as dermatoses – contact dermatitis and 
atopic dermatitis. However, Ni hypersensitizes the immune system and may cause hyperallergenic 
responses to many different substances. Because Ni can displace zinc from binding sites on 
enzymes it can affect abnormal enzymatic activity. Nickel sensitivity is observed to be three to five
 times more prevelant in females than in males. 
 
     Other laboratory tests or possible clinical findings that may be associated with Ni exposure are; 
hair elements analysis, presentation of multiple allergic sensitivities, dermatitis, positive patch test 
for ”Ni allergy”, proteinuria, hyperaminoaciduria (by 24-hour urine amino acid analysis). Administration 
of EDTA or sulfhydryl agents (DMPS, DMSA, D-penicillamine) may increase urine Ni levels; such 
chelator-induced elevations may or may not be associated with adverse health effects.

 BIBLIOGRAPHY FOR NICKEL 
 1. Tsalev D.L. and Z.K. Zaprianov Atomic Absorption Spectrometry in Occupational and 
Environmental Health Practice, CRC Press, Boca Raton FL, pp 173-78, 1983. 
 2. Carson B.L. et al. Toxicology and Biological Monitoring of Metals in Humans, Lewis Publishers, 
Chelsea MI, pp 162-67, 1986. 
 3. Nielsen F.H. in Modern Nutrition in Health and Disease ed. by Shils et al, Lea & Febiger, 
Philadelphia, PA, pp 279-81, 1994. 
 4. Medical and Biological Effects of Environmental Pollutants:  Nickel, Nat. Acad. Sci, 
Washington DC,1975. 

 19992019  Doctor’s Data, Inc.


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 5. Ambient Water Quality Criteria for Nickel, US EPA NTIS, Springfield, VA. Publ No. PB81-
117715,1980. 

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 19992019  Doctor’s Data, Inc.

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