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Serum Serum testing is recommended for determining iodine excess and monitoring overload in patients on iodine-containing medications. Iron Iron is distributed throughout the body, mainly into hemoglobin and also ferritin and hemosiderin, and transferred from organ to organ by a complex called transferrin. The most common indicator of deficiency is anemia and its corresponding symptoms: Fatigue Shortness of breath Pallor Dizziness Fainting Hemochromatosis is characterized by the classic triad of symptoms: Bronzing of skin Cirrhosis DM Laboratory Testing Diagnosis Several laboratory testing options are available to help identify iron deficiency or overload.
Serum Iron A serum iron measurement indicates the amount of iron bound to serum transferrin and does not include iron contained in serum as free hemoglobin. Total Iron-Binding Capacity Total iron-binding capacity is a measurement of the greatest amount of iron that transferrin can bind.
Transferrin Serum transferrin may be a better biomarker than iron-binding capacity because it is not affected by inflammatory diseases, which can yield false-negative results. Soluble Transferrin Receptor Soluble transferrin receptor testing can distinguish between iron deficiency anemia and anemia of chronic disease and can identify iron deficiency anemia in patients with inflammatory conditions in whom ferritin is increased. Ferritin Serum ferritin is an acute phase reactant, and concentrations are affected by inflammation, alcohol use, and obesity.
Erythrocyte Zinc Protoporphyrin Erythrocyte zinc protoporphyrin is an indicator of abnormal heme synthesis and is helpful in primary screening for basic iron deficiency; in combination with soluble transferrin receptor testing, it is particularly useful for monitoring iron supplement therapy. Other Testing Liver tissue testing can be useful to confirm hepatic iron overload, particularly in individuals with hemochromatosis and no common HFE gene variants, but less invasive iron testing should be used as an initial approach to diagnosis.
Lead Lead poisoning or lead toxicity generally occurs either in childhood or because of occupational exposure. Laboratory Testing Diagnosis Blood The best way to measure lead exposure is with a venous blood lead test. Source: CDC, Urine Urine lead testing may be useful to assess chronic lead exposure or in monitoring chelation therapy, but blood is the preferred specimen for routine lead exposure testing. Screening The CDC recommends that all children should have one BLL test performed between 12 and 24 months; Medicaid-enrolled children are required to be tested at 12 months and at 24 months.
Evaluate exposure and consider removal from exposure. Perform monthly testing of BLLs. Magnesium Symptomatic magnesium deficiency is rare, but people with gastrointestinal disease, type 2 DM , and alcohol dependence are at risk for magnesium inadequacy.
Blood Erythrocyte measurements may be useful to assess tissue stores of magnesium, but no test alone is considered satisfactory to assess magnesium status. Urine Urine measurements may provide information on magnesium status, but no test alone is considered satisfactory to assess status.
Manganese Manganese is an essential trace element found in most foods, but excess can cause brain damage. Biologic function Bone metabolism, enterohepatic circulation Sources Groundwater, whole grains, beans, nuts, tea Signs and symptoms of deficiency Coagulopathy, dermatitis Signs and symptoms of excess Manganism neurotoxic condition characterized by tremors, abnormal gait, and facial muscle spasms Adequate daily intake Children: 1. Laboratory Testing Diagnosis Most laboratory testing is limited in measuring past exposure, given that manganese is excreted from the body within days.
Blood Both whole blood testing and erythrocyte testing may be useful as reasonable indicators of recent, active manganese exposure and modest indicators to identify exposed and nonexposed individuals. Urine Urine testing has limited utility for determining manganese exposure; it is most reliable only for severe depletion. Mercury Mercury has three forms: organic mercury compounds which accumulate in the food chain , inorganic mercury compounds, and elemental mercury. Criteria for Diagnosis An elevated whole blood or urinary mercury concentration is diagnostic for mercury exposure.
Laboratory Testing Diagnosis Urine Urinary mercury levels predominantly reflect acute or chronic elemental or inorganic mercury exposure but not organic mercury exposure; organic mercury is eliminated in the stool and not in urine. Blood Blood can be used to evaluate exposure to mercury of any form.
Nickel Food is the most common source of nickel exposure, but exposure can also occur from handling nickel-containing coins, jewelry, and electronic devices. Biologic function Aids in iron absorption, increases hormonal activity, involved in lipid and glucose metabolism, improves bone strength Sources Tea, nuts, seeds, soy beans, legumes, cocoa, certain grains, certain canned foods, cigarettes Signs and symptoms of deficiency Slow growth, low hemoglobin concentrations, impaired glucose metabolism Signs and symptoms of excess Shortness of breath, headache, nausea, vomiting, rash allergy Recommended daily adult intake Not established Biologic half-life 28 hrs Source: Institute of Medicine, ; ATSDR, ; WHO, Indications for Testing Measurement of nickel is not recommended in asymptomatic individuals or individuals with a low likelihood of exposure.
Laboratory Testing Diagnosis Urine Urine is the preferred specimen to determine exposure. Serum Serum nickel concentrations may be informative in the investigation of toxic exposure. Selenium Selenium is a required element for antioxidant balance, thyroid hormones, and immunity ; however, excess can cause selenosis, which is characterized by nerve damage. Laboratory Testing Diagnosis Urine Urine selenium is the preferred indicator of selenium status, given that excess selenium is excreted in urine.
Blood Erythrocyte testing is most appropriate to assess selenium tissue stores, but urine testing is preferred to evaluate deficiency or toxicity. Thallium Thallium has no physiologic function in humans.
Laboratory Testing Diagnosis Urine Urine thallium testing is useful for determining chronic thallium exposure. Blood Blood may be an indicator of recent, acute exposure, but thallium does not stay in the blood long and is quickly distributed to body tissues.
Zinc Zinc is present in air, soil, water, and all foods, as well as many commercial products. Urine Urine zinc is an insensitive biomarker, but it may be helpful as an indicator of acute toxicity. Serum Assay. Preferred test for routine screening Use to assess aluminum toxicity due to dialysis.
Aluminum, Serum Urine Assay. Preferred test for chronic exposure. Aluminum, Urine Blood Assay. Use to assess recent antimony exposure. Antimony, Blood Urine Assays. Preferred test for assessing acute or chronic arsenic exposure Use to differentiate between toxic inorganic and methylated species as well as benign organic forms. Arsenic, Urine with Reflex to Fractionated Arsenic, Random Urine with Reflex to Fractionated Use to identify species of arsenic. Arsenic, Fractionated, Urine Arsenic, Blood Hair Assay.
Arsenic Analysis, Hair Beryllium Lymphocyte Proliferation. Recommended test for identifying beryllium sensitization and CBD. Beryllium Lymphocyte Proliferation, Blood Use to confirm an exposure to beryllium. Beryllium Quantitative, Serum or Plasma Use to assess acute or chronic bismuth exposure. Bismuth, Blood Use to assess chronic exposure and body burden. Cadmium, Urine Cadmium, Random Urine Use to assess acute toxicity.
Cadmium, Blood OSHA Test. Use to monitor occupational exposure Includes both cadmium blood and urine. Components: cadmium, blood; cadmium, urine; betamicroblobulin, urine. Use to investigate or monitor chromium exposure Preferred test for hexavalent chromium exposure.
Chromium, RBC May be useful in the assessment of deficiency or overload Acceptable test for evaluating metal ion release from metal-on-metal joint arthroplasty.
Chromium, Serum Use to monitor short-term exposure. Chromium, Urine Preferred test for evaluating metal ion release from metal-on-metal joint arthroplasty Use to assess occupational exposure or toxic ingestion.
Cobalt, Blood Use to assess occupational exposure or toxic ingestion. Cobalt, Serum or Plasma Use to assess acute exposure. Cobalt, Urine Useful in the assessment of deficiency or overload. Copper, Serum or Plasma May be useful in the assessment of copper overload or response to copper-reducing therapies Directly measures the free nonceruloplasmin bound fraction of copper.
Copper, Free, Serum or Plasma Ceruloplasmin Assay. May be used as initial screening test in Wilson disease or copper transport disorders. Ceruloplasmin Useful in the assessment of overload. Copper, Urine Copper, Random Urine Liver Assay. May be useful when related serum or urine assessments are inconclusive. Copper, Liver May be useful for exposure monitoring or investigation May be useful to assess the intracellular stores and general homeostasis of copper Not recommended for clinical diagnosis.
Copper, Red Blood Cells Recommended for the assessment of iodine nutritional status. Iodine, Urine Recommended for determination of iodine excess and monitoring iodine overload in patients administered iodine-containing medications Test reports total iodine but does not determine species.
Iodine, Serum Aids in the diagnosis of iron deficiency anemia and iron overload. Iron, Plasma or Serum Aids in the diagnosis of iron deficiency anemia and iron overload Includes calculated transferrin saturation.
Iron and Iron Binding Capacity Transferrin, Serum Use to distinguish iron-deficiency anemia from anemia from chronic disease. Soluble Transferrin Receptor Aids in the diagnosis of iron deficiency anemia and iron overload Use to monitor treatment of hemochromatosis. Ferritin Use to indicate chronic exposure to lead, primarily in industrial setting.
Other Testing. Iron, Liver Use to detect iron deficiency anemia, hemochromatosis, and hemosiderosis. Iron Stain Blood Assays. Recommended for routine testing for lead exposure. Lead, Blood Venous Recommended for routine testing for lead exposure in pediatric populations. Lead, Blood Capillary Recommended for assessment of industrial lead exposure in adults.
Lead, Industrial Exposure Panel, Adults Use to assess chronic lead exposure or monitor chelation therapy. Lead, Urine Lead, Random Urine Use to determine effects of lead poisoning. Preferred test to assess magnesium deficiency. Magnesium, Plasma or Serum Use to assess tissue stores. Magnesium, RBC Magnesium, Urine Magnesium, Fecal Reasonable indicator of recent, active exposure Modest indicator for distinguishing exposed from nonexposed individuals Recommended for monitoring potential accumulation with total parenteral nutrition.
Manganese, Whole Blood Reasonable indicator of recent, active exposure Modest indicator for distinguishing exposed from nonexposed individuals May be useful in long-term, low-dose manganese exposure. Manganese, RBC Reasonable indicator of recent, active exposure Modest indicator for distinguishing exposed from nonexposed individuals. Manganese, Serum Limited utility in determining exposure. Manganese, Urine Preferred test for chronic mercury exposure May be useful in monitoring chelation therapy.
Mercury, Urine Mercury, Random Urine Mercury, Whole Blood Preferred test for the determination of exposure. Nickel, Urine May be informative in the investigation of toxic exposure. Nickel, Serum Preferred test to assess for toxicity and deficiency. Selenium, Urine Use to assess recent intake. Selenium, Serum or Plasma Selenium, RBCs Biomarker of chronic exposure.
Thallium, Urine Biomarker of acute exposure. Thallium, Whole Blood Use to assess for acute deficiency. Zinc, Serum or Plasma Use to assess for acute toxicity.
Zinc, Urine Limited utility as an indicator of deficiency May be useful to assess the intracellular stores and general homeostasis of copper. Zinc, Red Blood Cells Limited utility as an indicator of deficiency. Zinc Quantitative, Whole Blood Heavy Metal Panel Tests. Heavy Metals Panel 3, Blood Components: arsenic, lead, mercury. Components: arsenic, arsenic fractionation, lead, mercury. Heavy Metals Panel 4, Blood Components: arsenic, cadmium, lead, mercury. Components: arsenic, arsenic fractionation, cadmium, lead, mercury.
Components: arsenic, arsenic fractionation, cadmium, copper, lead, mercury, zinc. Medical Experts Contributor. CDC - Biomonitoring summary antimony U. CDC - Arsenic U. CDC - Cobalt U. CDC - Lead U. CDC - Biomonitoring summary lead U. Bright Futures. Recommendations for preventive pediatric health care. CDC - Mercury U. CDC - Biomonitoring summary mercury U. Emergency Toxicology. Iron Deficiency Anemia. Renal Function Markers - Kidney Disease. Acute exposure: headache, nausea, dizziness, metallic taste, followed by vomiting, diarrhea , intestinal spasms Chronic exposure: arrhythmia, respiratory irritation, eye irritation, spontaneous abortion miscarriage or premature birth, dermatitis, damage to liver and spleen.
Acute: abdominal pain, vomiting, diarrhea , muscle cramps, high blood pressure, rapid heart rate Chronic: hyperpigmentation of skin, muscle weakness, anemia , leukopenia, skin lesions, skin cancer, sensory-predominant peripheral neuropathy. Weakness, fatigue, difficulty breathing, rash or ulcers on open skin, anorexia, weight loss.
Pharmaceuticals for treatment of nausea, vomiting, diarrhea. Acute: foul breath, oral mucosal lesions, renal toxicity Chronic: discoloration of skin, encephalopathy manifesting as memory loss, delirium, psychosis, insomnia, seizures. Source: Slikkerveer, Shellfish, liver and kidney meats, tobacco products and tobacco smoke, contaminated water.
Acute: abdominal pain, vomiting, diarrhea Chronic: kidney disease leading to glucosuria and proteinuria, lung damage, bone weakness. Helps in sugar, protein, and fat metabolism Potentiates the action of insulin in patients with impaired glucose tolerance May also improve lipid profiles proven in animal studies but not in humans. Fish, nuts, green vegetables, cereals, drinking water, metal-on-metal prosthetic implants.
Source: CDC, ; Tvermoes, Source: Institute of Medicine, ; Barceloux, Hypertension, renal damage, cognitive dysfunction, spontaneous abortion miscarriage.
This is a critical level Immediate medical evaluation is recommended Consider chelation therapy when symptoms of lead toxicity are present. Children: 1. Source: Institute of Medicine, ; Crossgrove, Fish, shellfish, air, water, dental amalgams, thermometers, compact fluorescent light bulbs. Acute: headaches, vomiting, dyspnea, chest pain, fever, impaired pulmonary function, papular erythema Chronic: tremors, gingivitis, erethism, headache, short-term memory loss, anorexia, paresthesia, dysarthria, visual field constriction, blindness, hearing impairment.
Source: Park, ; CDC, Tea, nuts, seeds, soy beans, legumes, cocoa, certain grains, certain canned foods, cigarettes. It is present in many foods including organ meats, shellfish, chocolate, beans and whole-grain cereals.
In addition to its role in formation of enzymes, zinc improves immune function, helps clot blood, maintains sense of taste and smell, keeps skin healthy and enables normal growth and development. You can obtain sufficient amounts of zinc by regularly eating eggs, seafood, red meats, fortified cereals and whole grains.
Chromium is an important trace mineral that is necessary for normal functioning of insulin, a hormone that maintains blood sugar levels. It is also essential for metabolism of carbohydrates, proteins and fats. Selenium, along with vitamin E works as an antioxidant that prevents damage of cells, may prevent some cancers and is essential for the normal functioning of the thyroid gland. Meat, seafood, nuts and cereals are good sources of selenium.
Manganese not only helps in the formation of enzymes, but is also necessary for their activation. It works as an antioxidant, helps develop bones and heals wounds by increasing collagen production.
Good sources of manganese include pineapple, nuts, whole grains and beans. Like manganese, molybdenum helps activate some enzymes and enables normal cell function.
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