Actual test done Dec 14, 2019 by 61 year old male.
LAB #: #####-####-##
PATIENT: #### #####
CLIENT #: ######
Thallium Urine Test
No pre/post information available
pH upon receipt:
timed: 7 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.
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 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 Gadolinium (Gd) is higher than expected. Gadolinium is one of
the most abundant ”rare-earth” elements but is never found as a free element in nature.
Gadolinium has no known biological role in humans.
Toxicity is rarely associated with Gd due to its poor gastrointestinal absorption (it is suspected
that very little Gd is absorbed from the gastrointestinal tract (<0.05%). If exposure to high enough
doses and/or if absorption does occur, symptoms of acute toxicity may develop, including abdominal
cramps, diarrhea, lethargy, muscular spasms, and even eventual death due to respiratory collapse.
Gadolinium salts can cause irritation of the skin and eyes and are suspected to be possible
carcinogens. As reported by Perazella (2009) Gadollinium-based contrast (GBC) agents have been
linked on occasion with a rare systemic fibrosing condition called nephrogenic systemic fibrosis
(NSF) and their use in patients with even mild kidney disease should be avoided (parenteral
Gd is often used in alloys (e.g. chromium, iron). Other technical uses include the phosphors of
color television tubes and in making magnets and electronic components such as recording heads
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for video recorders and in the manufacture of compact disks and computer memory. In medicine
Gd, chelated with diethylenetriaminepentaacetic acid (DTPA), is used as a non-radioactive
contrasting agent in magnetic resonance imaging and has a half-life in blood of about 90 minutes.
However, residual Gd is retained in tissues for quite some time. It is also used in control rods for
nuclear reactors and power plants, in making garnets for microwave applications.
EDTA effectively chelates Gd therefore urinary Gd might be higher than average post-Ca-EDTA
provocation, particularly in patients who have had Gd-enhanced MRIs.
Perazella M. Current Status of Gadollinium Toxicity in Patients with Kidney Disease. Clin J Am
Soc Nephrol 4: 461-69, 2009.
1999–2019 Doctor’s Data, Inc.
1999–2019 Doctor’s Data, Inc.