Heavy metals urine

Keywords: Cadmium urine, Cadmium, Thallium

Specimen:

Random or 24 h urine collected into a trace element free container.

If the exposure to a heavy metal is not recent, testing should be done following intravenous calcium EDTA infusion.

Method:

Inductively coupled plasma mass spectrometry (ICP-MS).

Lead, Mercury, Arsenic, Cadmium are measured routinely; others eg, Thallium and Uranium are usually assayed only on specific request.

Reference Interval:

Arsenic: < 2.0 μmol/L (< 40 nmol/mmol Creat)

Cadmium: < 40 nmol/L (< 3 nmol/mmol Creat)

Copper: < 1 μmo​l/L (< 0.5 μmol/day)

Lead: < 0.4 μmol/L (​24 h < 0.3 μmol/day; spot < 21 nmol/mmol Creat)

Manganese: < 3 μmol/L (24 h 3-40 nmol/day; spot < 3.4 nmol/mmol Creat)

Mercury: < 0.1 μmol/L (spot < 10 nmol/mmol Creat)

Thallium: < 50 nmol/L (24 h < 20 nmol/day; spot < 1 nmol/mmol Creat)

Application:

Monitoring of patients at risk from occupational or environmental exposure.

Suspected poisoning. Investigation of patients with suspicious clinical features eg, neuropathy, encephalopathy, renal failure, Fanconi syndrome.

Interpretation:

Elevated results indicate exposure.

Normal results exclude recent, clinically significant exposure to those metals analysed. Higher cut-offs may apply for industrial exposure.

See also Arsenic urine, Lead urine, Copper urine and Mercury urine.

Reference:

Baselt RC and Cravey RH. Disposition of Toxic Drugs and Chemicals in Man. 3rd ed. 1989. Year Book Medical Publishers.

Hu H. Prim Care 2000; 27(4): 983-996.