Conclusions

Laboratory testing is critical to the identification and monitoring of toxic elemental exposures. Toxic elements are much like drugs in that they exhibit characteristic absorption, distribution, metabolism, and elimination properties. As such, the utility of laboratory results requires consideration of the circumstances surrounding an exposure and controlled collection of the most appropriate specimen(s). Unlike drugs, however, external contamination is common to elemental testing, particularly with aluminum and lead. Thus, elevated results should be confirmed with a second specimen. Elemental loss of mercury is also common and should be considered when faced with results that are inconsistent with the clinical scenario. Specialized testing may also be required. For arsenic, an elevation in total concentrations cannot be interpreted without additional testing to fractionate or speciate the specimen to determine whether the elevated total result is due to toxic inorganic forms or relatively non-toxic organic forms of arsenic. Panels designed to detect a wide variety of potentially toxic elements are available clinically. Once confirmed, a toxic elemental exposure can be managed to minimize clinical consequences. Such management should include laboratory testing to monitor decontamination as well as identify any rebound exposures resulting from redistribution of tissue stores.

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