Also known as:Toxic Metals
Formal name:Heavy Metals Panel
Related tests:Lead, Mercury, Iron, Copper
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Why Get Tested?
To screen for, detect, and monitor excessive exposure to specific heavy metals
When to Get Tested?
Periodically when you work with heavy metals, or when a healthcare practitioner suspects that you may have been exposed
A blood sample drawn from a vein in your arm or a 24-hour urine sample; rarely, a hair or nail sample, tissue sample, or other body fluid sample
Test Preparation Needed?
48 hours before collection, you should not eat seafood. If you have had a procedure in which either gadolinium- or iodine-containing contrast media has been administered, wait 96 hours before sample collection.
How is it used?
Heavy metals testing is used to screen for or to diagnose heavy metal poisoning in those who may have been acutely or chronically exposed to one or more heavy metals and to monitor excessive metal concentrations in those who work with various heavy metals. Such occupations include construction work, mining, radiator repair shops, and firing ranges. Testing is also conducted to monitor the effectiveness of chelation therapy, a treatment to rid the body of high amounts of a heavy metal.
Heavy metal panels are set up in groups of tests that mirror potential metal exposures. A laboratory may offer several different groupings that are specific for either blood or urine. A healthcare practitioner will order the metals panel that corresponds to the person's occupation, hobby, suspected exposure, and/or clinical symptoms. Some of the metals that are more commonly tested include:
If a healthcare practitioner suspects that someone has been exposed to a specific metal, such as lead, the practitioner may order that specific test instead of, or in addition to, a panel. Lead is usually ordered by itself when screening for exposure, especially in children because of how susceptible they are to its effects. Some metals can also be measured in fluid, hair, fingernails, and body tissues. Usually these are ordered individually.
When is it ordered?
A heavy metals panel may be ordered if a healthcare practitioner suspects that someone has been acutely or chronically exposed to one or more heavy metals. Signs and symptoms of heavy metal exposure will vary in nature and intensity depending on the type and quantity of metal involved; early symptoms of poisoning can be missed because they are often non-specific. Excessive exposure and damage to several different organs can occur even if a person has no, few, or nonspecific symptoms. Some signs and symptoms of metal poisoning may include:
- Abdominal pain, nausea, vomiting, and diarrhea
- Nervous system symptoms such as numbness, tingling of hands and feet, weakness
- Kidney damage
- Liver damage
- In the lungs - irritation, fluid accumulation (edema)
- Brain dysfunction, memory loss
- Mees lines (horizontal lines on nails)
- Changes in behavior
- Malformed bones in children, weakened bones
- In pregnant women - miscarriage, premature labor
People who may be exposed to metals in the workplace are usually monitored periodically. Safety measures minimize risk to employees and help address problems when they are identified. The U.S. Occupational Safety and Health Administration (OSHA) regulates the use and monitoring of several toxic metals that may be found on the job. If excessive concentrations are detected, affected persons are monitored and steps are taken to reduce their exposure.
What does the test result mean?
Care must be taken in the interpretation of heavy metals tests. A low level of a heavy metal in the blood does not necessarily mean that excessive exposure has not occurred. Heavy metals do not stay in the blood and will not be present in the urine for extended periods of time. Lead, for instance, migrates from the blood into the body's organs and over time is incorporated into the bones. If someone was chronically exposed to lead, then that person might have lead in his or her blood, urine, organs, and bones.
Very low levels of many heavy metals may be present in the blood and urine of apparently healthy people because these metals are present throughout our environment. Recommendations for safe levels of heavy metals depend on the age of the person and may change over time as more information about their safety emerges.
According to the Centers for Disease Control and Prevention, for example, scientists found measurable mercury in over 8,000 participants in a study conducted in 2004. A conclusion they came upon was that both blood and urine levels of mercury tend to increase with age. They also state that finding a measurable amount of mercury in blood or urine does not imply that levels of mercury cause an adverse health effect. Monitoring studies on mercury levels in the body provide physicians and public health officials with reference values so that they can determine whether people have been exposed to higher levels of mercury than are found in the general population.
To learn more about minimal risk levels and/or health effects of a particular metal, visit the ToxFAQs™ section of the Agency for Toxic Substances and Disease Registry (ATSDR) website.
Is there anything else I should know?
Exposures to the same amounts and types of heavy metals will not necessarily lead to the same effects in different people because they absorb and eliminate metals at different rates. Those who have underlying health conditions may be more vulnerable than others to the same exposures.
Trace concentrations of heavy metals are monitored and minimized but are almost impossible to avoid altogether. For instance, naturally-occurring arsenic is a contaminant that can be found in some sources of drinking water throughout the world. Small amounts of mercury are found in fluorescent light bulbs and some thermometers. If these break, the mercury can be released. Methylmercury, an organic form of mercury that is produced by bacteria in water, can build up in fish over time. Concentrations vary regionally and with the size of the fish. The highest levels are typically found in bigger and older fish. In most cases, the benefits of eating fish outweigh the small risk of ingesting excess mercury. However, women who are pregnant may want to take extra precautions. The March of Dimes recommends that pregnant women avoid certain types of large fish during their pregnancy because of mercury's potential harm to the fetus.
Lead was once routinely used in paint, plumbing pipes, and as an additive in gasoline. In the U.S., these environmental sources of lead have decreased, but it can be present in the existing paint and plumbing of older homes. In Flint, Michigan, in 2015, for example, no corrosion control was used to prevent lead from entering the water when the town switched its water source from Detroit's water to the Flint River's water (on top of the fact that the river contained eight times as much chloride as Detroit's water). When water from the river flowed through those pipes, it ate away at the pipes, which caused lead to enter the water supply and was deemed unsafe to drink.
When lead house paint deteriorates, it creates lead chips and dust that can be stirred up with the movement of air and can find their way into the soil around the house. While anyone may be harmed by lead exposure, children are at the highest risk. They may eat paint chips, mouth painted surfaces, breath in lead dust, and play in contaminated soil.
In addition to lead, other heavy metals such as arsenic and cadmium have been found to contaminate some toys and jewelry.
All of the sources of heavy metal exposure in the air, water, food supply, and in the environment are controlled, regulated, and monitored by three governmental agencies and the medical community. The Environmental Protection Agency (EPA) evaluates the effects of exposures, regulates industrial emissions, and establishes maximum contaminant levels for heavy metals such as arsenic in drinking water. The Food and Drug Association (FDA) establishes limits for metals in food, and the Centers for Disease Control and Prevention (CDC) recommends testing young children for lead, especially for those who live in or routinely visit a house built before 1978.
What is being tested?
A heavy metals panel is a group of tests that measures the quantity of specific potentially toxic metals in the blood, urine or, more rarely, in the hair or other body tissue or fluid. A laboratory may offer several different groupings of heavy metals panels as well as tests for individual metals. The most common combination includes Lead, Mercury, and arsenic. Other panels may include one or more additional metals, such as cadmium, Copper, or zinc. A healthcare practitioner will select which metals to test for based upon what a person may have been exposed to in addition to clinical symptoms.
The term "heavy metals" is loosely defined. It is related to the periodic table of elements and refers to a variety of elements with high density or metallic properties. These elements are found naturally throughout the environment and are also used by industries to manufacture a wide range of common products. Some of them, such as iron, copper, selenium, molybdenum, and zinc, are required in trace amounts by the body for normal function but can be toxic at higher levels. Significant concentrations of any of the heavy metals can be irritating or damaging to the body and can contaminate soil, air, food, and water, persisting indefinitely in the environment. Because they are a source of potential injury, the term "heavy metals" is frequently used interchangeably with the term "toxic metals."
The signs and symptoms that a person may experience depend upon the type of metal, its form, the quantity, the length of exposure, the type of exposure, the age of the person, and the person's general state of health. Some metals are much more toxic than others, and one form of a metal may be more harmful than other forms, such as an organic versus an inorganic metal compound. How a person is exposed can influence the amount of metal absorbed and the part(s) of the body that are affected. For example, a metal that does little when it is held in someone's hand, or is only moderately harmful and poorly absorbed when swallowed, may be much more toxic and cause severe lung damage when its vapors are inhaled.
Severe acute exposure can cause damage and, in some cases, can be life-threatening, but moderate exposures over time should also be monitored. The body is able to process small amounts of heavy metals, but moderate to large quantities can accumulate in the kidneys, liver, bones and brain. Some metals are considered carcinogenic - they increase the risk of developing cancer - and some can affect the body's ability to produce red and white blood cells. Fetuses and young children are at the highest risk because exposures to low or moderate concentrations can affect physical and mental development and can permanently damage the organs and brain. Many of the metals can be passed from the mother to the fetus, and some can be passed to the infant in breast milk.
How is the sample collected for testing?
Heavy metal testing is usually performed on a blood sample obtained by inserting a needle into a vein in the arm or on a 24-hour urine collection. Special metal-free blood or acid-washed urine containers are used to minimize the potential for sample contamination by any outside sources of metal.
Urine and blood can both be used for heavy metal testing, but they do not necessarily test for the same forms of a metal. For instance, methylmercury - an organic highly toxic form of mercury found in fish - can be detected in the blood but not in urine. Urine is the preferred sample for measuring inorganic forms of mercury and for measuring arsenic.
Hair and fingernail analysis can give an indication of exposure that has occurred over time or in the past but does not show recent exposures. Blood and urine will reflect exposures that are chronic or that have happened in the last few days.
In rare cases, a biopsy will be performed to obtain a tissue sample for testing.
NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.
Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.
Is any test preparation needed to ensure the quality of the sample?
Refrain from eating seafood 48 hours before sample collection. If you have had a procedure in which either gadolinium- or iodine-containing contrast media has been administered, wait 96 hours before sample collection.
- How long will it take to get the results of my test?
Heavy metal analysis is not done on a routine basis and is frequently performed at a reference laboratory, so the results are likely to take several days.
- How is someone exposed to toxic metals?
Heavy metals can enter the body through the skin or by inhalation or ingestion. Toxicity occurs when the metals displace the essential elements in the body and begin to affect the normal function of various organs. Most people will never be sufficiently exposed to be harmed or require testing.
The majority of acute and chronic exposures occur in the workplace, especially in industries that use metals to manufacture products; such as the cadmium, lead, and mercury used in batteries and the arsenic used in some pesticides. Exposures can also occur in agricultural workers, in people whose job it is to clean up contaminated environmental sites, in those who work with certain products such as auto mechanics working with car batteries, and in those with hobbies that involve the use of metals such as the lead used by stained glass artisans.
Most exposures to excessive concentrations in the general population are primarily due to increased levels of metals in food or water, products that they use, or soil contamination in or near the areas that they work and live.
- How can I test my soil, water, or the paint on my house for heavy metals?
- In addition to lead, mercury, arsenic, cadmium and chromium, what are some other metals that may be tested?
Some metals that are tested less frequently in suspected toxicity include:
© 2017 American Association for Clinical Chemistry, republished from Lab Tests Online.*
Descriptions of clinical laboratory tests were originally prepared for use on Lab Tests Online, an award-winning patient education website on clinical laboratory testing. Lab Tests Online is produced by the American Association for Clinical Chemistry (AACC), a global scientific and medical professional organization dedicated to clinical laboratory science and its application to healthcare. The Lab Tests Online website is developed in collaboration with other laboratory professional societies and is funded in part through corporate sponsorships.