Actual test done June 18, 2019 by 49 year old male.
LAB #: #####
PATIENT: ##### ####
CLIENT #: #####
DOCTOR: ##### ####
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Paladium Urine Test
pH upon receipt:
timed: 6 hours
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.
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.
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,
1999–2019 Doctor’s Data, Inc.
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
5. Harrison’s Principles of Internal Medicine, 13th ed., McGraw Hill, New York, NY, pp 2461-62,
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 (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.
1999–2019 Doctor’s Data, Inc.
This individuals urine Cesium (Cs) level is higher than expected, reflecting exposure to Cs but symptoms
may not be evident. Very high levels of Cs in urine are often associated with the use of cesium chloride as
a questionable anti-cancer treatment. Cesium is a naturally-occurring element found in rocks, soil and dust
at low concentrations. It is present in the environment only in the stable form of Cs133; the radioactive isotopes
134Cs and 137Cs are not measured or reported by Doctor’s Data. Natural deposits of Cs ores occur in Main,
South Dakota and Manitoba (Bernic Lake), Canada. Cesium may bio-accumulate in aquatic food chains; higher
levels of cesium have been found in Pacific deep-sea fish and local shellfish since the 2011 Fukoshima reactor
accident. Cesium may be used in high-density drilling fluids (oil and gas industry) and may contaminate local
water and vegetation; Cs has been found in cow’s milk. Cesium may occur naturally in mineral waters; one
study analyzed the Cs concentration in 163 mineral and thermal waters and found the level ranged from 4.5
to 148 µg per liter.
Cesium can be absorbed after oral ingestion, upon breathing contaminated air and through contact with the
skin. Cesium is readily absorbed across the brush border of the intestines in a manner similar to potassium
and most is eventually excreted through the urine and feces. The biological half-life of Cs in humans ranges
from 15 days in infants to 100-150 days in adults.
The cesium-137 isotope is used in cancer treatments, for ventricular function and pulmonary imaging
studies, industrial radiology, and for food and instrument sterilization; Cs137 agents may contain small
amounts of Cs133. Non-radioactive cesium chloride may be advertised on the internet as ”high pH therapy.”
Currently there is no support in the scientific literature for that purpose as advertised. Radioactive Cs
isotopes may contaminate soil at nuclear waste sites. Cesium may be used in industry for the production of
photoelectric cells, vacuum tubes, spectrographic instruments, scintillation counters, DNA biochemistry, in
various optical or detecting devices.
Target organs of potential toxic effects of Cs are the liver, intestine, heart, and kidneys. Physiological effects
of excessive Cs include ventricular arrhythmias and displacement of potassium from muscle cells and
erythrocytes. Cesium can have significant effects on both the central and peripheral nervous systems.
Cesium may cause epileptic seizures because it can share the same receptor as the excitatory bioamine
glycine. Cesium can interfere with active ion transport by blocking potassium channels and also can
interfere with lipid metabolism. Excessive Cs may modify plasma membrane integrity, alter cytoplasmic
components and cause cytogenetic damage.
It is unlikely that children or adults would be exposed to enough Cs133 to experience any health effects that
could be related to the stable Cs itself. Animals given very large doses of Cs compounds have shown
changes in behavior, such as increased activity or decreased activity, but it is unlikely that a human would be
exposed to enough stable Cs to cause similar effects.
The isotope Cs137 is used in radiation therapy for certain types of cancer. Other medical uses of Cs are
monitoring left ventricular function with Cs137 iodide probes and monitoring pulmonary endothelial
permeability with Cs137 iodide crystal mini-detectors. Again, it is emphasized that Cs measured at Doctor’s
Datais Cs133, not Cs137. Environmental contamination by Cs137 as a result of radioactive fallout could be
a concern. Exposure to Cs may be assessed by hair elemental analysis.
Commonly used chelating agents are not effective binders of Cs.
1999–2019 Doctor’s Data, Inc.
Agency for Toxic Substances & Disease Registry (2015) Toxicological Profile for Cesium.
https://www.atsdr.cdc.gov/toxprofiles/TP.asp(c)id=578&tid=107 Accessed 21 February 2017
Bermejo-Barrera P, Beceiro-Gonzalez E, Bermejo-Barrera A, Martinez F (1989) Determination of cesium
in mineral and thermal waters by electrothermal atomic absorption spectrophotometry.
Microchemical Journal 1989 vol: 40 (1) pp: 103-108
Davis D, Murphy E, London R (1988) Uptake of cesium ions by human erythrocytes and perfused rat heart:
a cesium-133 NMR study. Biochemistry 1988 vol: 27 (10) pp: 3547-3551
Ikenoue T, Takata H, Kusakabe M, Kudo N, Hasegawa K, et. al. (2017) Temporal variation of cesium
isotope concentrations and atom ratios in zooplankton in the Pacific off the east coast of Japan.
Scientific Reports 2017 vol: 7 pp: 39874
Relman A (1956) The physiological behavior of rubidium and cesium in relation to that of potassium.
The Yale Journal of Biology And Medicine 1956 vol: 29 (3) pp: 248-62
Samadani U, Marcotte P (2004) Zero Efficacy With Cesium Chloride Self-Treatment for Brain Cancer.
Mayo Clinic Proceedings 2004 vol: 79 (12) pp: 1588
United States Geological Service (2006) Cesium.
https://minerals.usgs.gov/minerals/pubs/commodity/cesium/cesiumcs06.pdf Accessed 22 February 2017
Yamagata N, Iwashima K, Nagai T, Watari K, Iinuma T (1966) In Vivo Experiment on the Metabolism of
Cesium in Human Blood with Reference to Rubidium and Potassium. Journal of Radiation Research
1966 vol: 7 (1) pp: 29-46
Yorita Christensen KL (2013) Metals in blood and urine, and thyroid function among adults in the United
States 2007-2008. International Journal of Hygiene and Environmental Health 2013 vol: 216 (6) pp: 624-632
This individual’s urine level of Palladium (Pd) is higher than expected. Palladium may be found
uncombined (rarely) or in association with other metals such as platinum, other platinum-group
metals as well as with nickel and copper. It may be present in low levels in some soils and in the
leaves of some trees.
Palladium metal is generally regarded as having low toxicity as it is poorly absorbed when
ingested. However, it may cause skin, eye and respiratory irritation and allergic contact dermatitis
to Pd has been reported. The main contact sources are jewelry and dental materials (gold alloys).
With regard to toxicity, Pd compounds are another matter: these compounds are rarely
encountered by most people and should be regarded as toxic and carcinogenic. For example,
palladium chloride is toxic if swallowed, inhaled or absorbed through the skin and may cause bone
marrow, liver and kidney damage. However, Pd chloride was formerly used as a treatment for
tuberculosis (0.065 g per day; about 1 mg/kg body weight) with few adverse effects.
The characteristics of Pd (it is ductile, malleable, resistant to corrosion, easily fused and welded)
make it an acceptable material for jewelry making and dentistry. Pd can form many compounds
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and several complex salts. It is used in the field of communications in facing electrical contacts in
automatic switch gear, in the manufacture of many alloys including ”white gold” and can be
alloyed with platinum or substituted for it. Non-magnetic springs in clocks and watches, as well as
special coatings for mirrors, may be made of Pd. The chemicals industry uses Pd as a catalyst.
Until 1990 most catalytic converters, used in vehicles to remove unburned hydrocarbons from
exhaust emissions, utilized platinum (Pt) for this purpose but Pd now has replaced Pt as the main
ingredient. Currently Pd is finding wide application in manufacture of the tiny multi-layer ceramic
capacitors used in wide-screen television screens, computers and mobile phones.
DMPS, like other chelating agents studied, demonstrated no change in mortality of mice with acute
International Programme on Chemical Safety (IPCS), Chemical Safety Information from
Intergovernmental Organizations (INCHEM). Palladium. Environmental Health Criteria 226,
Platinum (Pt) is a nonessential element that can be found at elevated concentrations in urine with
excessive exposure. Industrial workers exposed to Pt (n = 27) showed higher concentrations in the blood
and urine (> 2 µg Pt/24 hours) in comparison to non-exposed workers.
Pt is poorly absorbed in the gut but may be absorbed via inhalation. Since it is a relatively rare
element, most Pt exposures are of occupational origin. In recent years, there may have been a slight
increase in environmental Pt due to the use of Pt as a catalyst in automobile exhaust converters. Pt is a
byproduct of copper refining and used as an alloy in dental and orthopedic materials. Symptoms of excess
exposure to Pt include: dermatitis, irritation of mucus membranes, dyspnea and wheezing (for inhaled Pt
dusts or salts), development of chronic allergic reactions (”platinosis”), nephrosis, and immunosuppression
(from Pt diamine salts).
Pt containing drugs, such as cisplatin, carboplatin, and oxaliplatin are used as chemotherapeutic agents.
Such drugs are extremely toxic and can be associated with nephrotoxicity with associated magnesium wasting
and hypomagnesemia, myelosuppression, ototoxicity, and neurotoxicity. Expect urinary Pt to be significantly
elevated after chemotherapy with the Pt-containing coumpounds. Observations at DDI indicate that EDTA, DMPS
and DMSA do not significantly increase urinary Pt excretion compared to pre-provocation levels. Hair Pt would
also most likely be elevated in such patients.
BIBLIOGRAPHY FOR PLATINUM
1. Van der Voef, G.B. and De Wolf, F.A., Human Exposure to Lithium, Thallium, Antimony, Gold and Platinum.
Chapt. 28, Toxicology of Metals. Chang, L.W. ed. CRC Press, Boca Raton, pp. 455-460, 1996.
2. Messerschmidt, F. et al., Fres. J. Anal. Chem. 343 (1992).
1999–2019 Doctor’s Data, Inc.
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.
1999–2019 Doctor’s Data, Inc.
1999–2019 Doctor’s Data, Inc.