To screen for, detect, and monitor excessive exposure to specific heavy metals
Periodically when you work with heavy metals, or when a healthcare practitioner suspects that you may have been exposed to one or more heavy metals
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
You should not eat seafood for 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.
A heavy metals panel is a group of tests that detects and measures 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 heavy metals panels as well as individual tests for metals. The most common combination includes:
Other panels may include one or more additional metals, such as cadmium, copper, or zinc. A healthcare practitioner will select which metals to test based on what you may have been exposed to and your signs and 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.
Heavy Metals Poisoning
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 you may experience depend upon the type of metal, its form, the quantity, the length of exposure, the type of exposure, your age, and your 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 you are 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 your 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 collect the sample to lower the risk of 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. For lead, blood more accurately correlates with adverse health effects than other fluids or tissues.
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. Independently, they are not to be used to determine exposure. Blood and urine will reflect exposures that are long-term (chronic) or that have happened in the last few days.
In rare cases, a biopsy is performed to obtain a tissue sample for testing.
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. For potential industrial exposure, optimal monitoring should be performed with samples collected at the end of the work week.
Heavy metals testing is used to:
As mentioned above, your healthcare practitioner may order the metals panel that corresponds to your occupation, hobby, suspected exposure, and/or clinical symptoms. Alternatively, if your healthcare practitioner suspects that you have been exposed to a specific metal, such as lead, your 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. If clinically indicated, additional testing to aid in diagnosis may be desired including but not limited to kidney and liver function test, X-rays and electrocardiograms.
A heavy metals panel may be ordered when you have signs and symptoms and/or your healthcare practitioner suspects that you have been acutely or chronically exposed to one or more heavy metals. It may be ordered periodically when you are treated for heavy metal poisoning.
Signs and symptoms of heavy metal exposure will vary in type and severity 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 you have no, few, or nonspecific symptoms. Some signs and symptoms of metal poisoning may include:
You may also be monitored periodically when you may be exposed to metals in the workplace. Frequency of monitoring will depend on level of initial exposure, presence or absence of ongoing exposure, and current intervention. 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.
Care must be taken in the interpretation of heavy metals tests. Your healthcare practitioner will interpret your results in the context of factors such as your risk of exposure, medical history, signs and symptoms, and physical exam.
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, moves from the blood into the body's organs and over time is incorporated into the bones. If you were chronically exposed to lead, then you might have lead in your 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 your age and may change over time as more information about their safety becomes available.
According to the Centers for Disease Control and Prevention (CDC), for example, scientists found measurable mercury in over 8,000 participants in a study conducted in 2004. The CDC concluded that both blood and urine levels of mercury tend to increase with age. Detecting 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.
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.
Heavy metals can be absorbed through the skin, inhaled, or by eating or drinking contaminated food or liquids. You can be poisoned 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 short-term and long-term 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.
Pregnant women at risk of metal toxicity such as lead can pass metals to their developing babies (fetuses). This is because lead is able to cross the placenta. Also, lead can be passed to infants through breast milk. When mothers should and should not to breastfeed will depend on blood lead levels.
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.
See the links under Related Content and explore the Environmental Protection Agency website. The EPA has information that can help you find a professional to evaluate your environment.
Some metals that are tested less frequently in suspected toxicity include:
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.
Sources Used in Current Review
2020 review performed by Penn Muluhngwi, PhD, NRCC, SC(ASCP).
(Oct 24, 2018) Sample, Jennifer A. Childhood lead poisoning: Management. UpToDate. Available online at https://www.uptodate.com/contents/childhood-lead-poisoning-management. Accessed on 04/06/2020.
(Mar 17, 2020) Goldman, Rose H and Hu, Howard. Lead exposure and poisoning in adults. UpToDate. Available online at https://www.uptodate.com/contents/lead-exposure-and-poisoning-in-adults. Accessed on 04/06/2020.
(Jan 07, 2019) Goldman, Rose H. Arsenic exposure and poisoning. UpToDate. Available at https://www.uptodate.com/contents/arsenic-exposure-and-poisoning. Accessed on 04/06/2020.
(©2020) Mayo Clinic Laboratories. Heavy Metals Screen, with Reflex, 24 Hour Urine. Available online at https://www.mayocliniclabs.com/test-catalog/Overview/48538. Accessed on 04/03/2020.
(Aug 30, 2019) National Library of Medicine. Mercury Law, Regulations and Policy. Available online at https://www.nlm.nih.gov/enviro/mercury-and-human-health.html. Accessed on 04/03/2020.
(June 18, 2018) Centers for Disease Control and Prevention. Lead Training and Medical Guidelines. Available online at https://www.cdc.gov/niosh/topics/lead/medical.html. Accessed on 03/30/2020.
Sources Used in Previous Reviews
(Updated 2008 August 07). U.S. Department of Labor Occupational Safety and Health Administration, Toxic Metals. Toxic Metals [On-line information]. Available online at http://www.osha.gov/SLTC/metalsheavy/index.html. Accessed 1/25/09.
Soghoian, S. and Sinert, R. (2008 July 18). Toxicity, Heavy Metals. eMedicine [On-line information]. Available online at http://emedicine.medscape.com/article/814960-overview. Accessed 1/18/09.
(1999 April 14). OSHA Regulated Toxic Metals. U.S. Department of Labor OSHA Safety and Health Topics [On-line information]. Available online at http://www.osha.gov/SLTC/metalsheavy/regulated.html. Accessed 1/25/09.
(2006 September). Aluminium. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts22.pdf. Accessed 1/25/09.
(1995 September). Antimony. ATSDR ToxFAQs [On-line information]. PDDF available for download at http://www.atsdr.cdc.gov/tfacts23.pdf. Accessed 1/25/09.
(2007 August). Arsenic. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts2.pdf. Accessed 1/25/09.
(2002 September). Berillyum. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts4.pdf. Accessed 1/25/09.
(2008 September). Cadmium. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts5.pdf. Accessed 1/25/09.
(2008 September). Chromium. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts7.pdf. Accessed 1/25/09.
(2008 May 23). Hexavalent Chromium. OSHA Safety and Health Topics [On-line information]. Available online at http://www.osha.gov/SLTC/hexavalentchromium/index.html. Accessed 1/25/09.
(2004 April). Cobalt. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts33.pdf. Accessed 1/25/09.
(2004 September). Copper. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts132.pdf. Accessed 1/25/09.
(2007 August). Lead. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts13.pdf. Accessed 1/25/09.
(2008 September). Manganese. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts151.pdf. Accessed 1/25/09.
(1999 April). Mercury. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts46.pdf. Accessed 1/25/09.
(2005 August). Nickel. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts15.pdf. Accessed 1/25/09.
(2003 September). Selenium. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts92.pdf. Accessed 1/25/09.
(1999 July). Silver. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts146.pdf. Accessed 1/25/09.
(1995 September). Thallium. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts54.pdf. Accessed 1/25/09.
(2005 August). Tin and Tin Compounds. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts55.pdf. Accessed 1/25/09.
(1995 September). Vanadium. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts58.pdf. Accessed 1/25/09.
(2005 August). Zinc. ATSDR ToxFAQs [On-line information]. PDF available for download at http://www.atsdr.cdc.gov/tfacts60.pdf. Accessed 1/25/09.
Podsiki, C. (2008 November). Chart of Heavy Metals, their Salts and Other Compounds. American Institute for Conservation of Historic and Artistic Works [On-line information]. PDF available for download at http://aic.stanford.edu/health/guides/heavy_metals_table_11_08.pdf. Accessed on 1/25/09.
Roth, E. and Quig, D. (2008 May). Toxic Metals, Why Hair Analysis Deserves Another Look. Clinical Laboratory News v 34, (5) [On-line information]. Available online at http://www.aacc.org/publications/cln/2008/may/Pages/series_0508.aspx. Accessed on 1/25/09.
Clarke, W. and Dufour, D. R., Editors (© 2006). Contemporary Practice in Clinical Chemistry: AACC Press, Washington, DC. P. 474.
Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Burtis CA, Ashwood ER and Bruns DE, eds. 4th ed. St. Louis, Missouri: Elsevier Saunders; 2006, Pp. 1371-1374.
Harrison's Principles of Internal Medicine. 16th ed. Kasper D, Braunwald E, Fauci A, Hauser S, Longo D, Jameson JL, eds. McGraw-Hill, 2005, Pp. 2577-2580.
Methylmercury poisoning. (Updated 2013 Mar 22). MedlinePlus Medical Encyclopedia. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/001651.htm. Accessed on 5/21/13.
Soghoian, S. and Sinert R. (Updated 2011 May 6). Heavy Metal Toxicity. eMedicine Medscape Reference. Available online at http://emedicine.medscape.com/article/814960-overview#a0199. Accessed on 5/14/13.
Martin, C. J., Werntz C. L., and Ducatman A. M. (2004 Dec). The interpretation of zinc protoporphyrin changes in lead intoxication: a case report and review of the literature. National Center for Biotechnology Information PubMed. Available online at http://www.ncbi.nlm.nih.gov/pubmed/15576877. Accessed on 5/14/13.
Centers for Disease Control and Prevention. Lead Prevention Tips. (2012 June 25 Updated). Available online at http://www.cdc.gov/nceh/lead/tips.htm. Accessed on 5/21/13.
China To Review Report Of Cadmium In Kid's Jewelry. By Jeremiah Marquez, AP Business Writer, 01/12/2010. Available online at http://www.manufacturing.net/news/2010/01/china-to-review-report-of-cadmium-in-kids-jewelry. Accessed May 2013.
'One third of Chinese toys contain heavy metals'. By Malcolm Moore, Shanghai and James Hall, 08 Dec 2011. The Telegraph. Available online at http://www.telegraph.co.uk/news/worldnews/asia/china/8944028/One-third-of-Chinese-toys-contain-heavy-metals.html. Accessed May 2013.
2016 review performed by Manoj Tyagi, PhD, NRCC CC, Medical Lab Director, Captiva Lab.
(Oct 14, 2010) Food and Drug Administration. FDA issues warnings to marketers of unapproved 'chelation' products. Available online at http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm229320.htmwww.epa.gov/mercury/. Accessed February 2016.
(January 2016) Environmental Protection Agency. Lead. Available online at http://www.epa.gov/lead/. Accessed February 2016.
Sanburn, Josh. Flint's Water Crisis Explained in 3 GIFs (Jan. 24, 2016). Time Magazine. Available online at http://time.com/4191864/flint-water-crisis-lead-contaminated-michigan/. Accessed February 9, 2016.
(July 23, 2013) Centers for Disease Control and Prevention. National Biomonitoring Program, Mercury. Available online at http://www.cdc.gov/biomonitoring/Mercury_FactSheet.html. Accessed February 9, 2016.
Occupational Safety & Health Administration. Toxic Metals. Available online at https://www.osha.gov/SLTC/metalsheavy/. Accessed February 2016.
(Mar 24, 2015) Adal A. Heavy Metal Toxicity. Medscape Reference. Available online at http://emedicine.medscape.com/article/814960-overview. Accessed March 2016.
(©2016) Mayo Medical Laboratories. Heavy Metals Screen, 24 Hour, Urine. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/8633. Accessed March 2016.
(©2016) Soloway R. Poison Control, National Capital Poison Center: Chelation Therapy. Available online at http://www.poison.org/articles/2011-mar/chelation-therapy. Accessed March 2016.