Interpretation Of Toxic Element Testing Results

Clinical interpretation of toxic element results requires consideration of the reason for testing, the relationship between time(s) of exposure and time of specimen collection, the extent (dose) of exposure, whether the exposure was acute or has been chronic, the elemental form or species involved in the exposure, the route of exposure, the kinetics of the element in question, and interpretive guidelines such as thresholds for toxicity and case reports of fatalities. Reference intervals are widely available for most elements but are dependent on the geographical location from which the people studied live because elemental concentrations and diet vary from place to place. However, toxic thresholds for the elements are in general much higher than the upper limit of common reference intervals. Biological exposure indices are published by the American Conference of Governmental Industrial Hygienists (ACGIH) that provide additional interpretive value, particularly related to occupational exposures. Table 1 details the preferred specimen, common sources of exposure, and clinical symptoms of excess of six toxic elements most frequently analyzed in the clinical laboratory: aluminum, arsenic, cadmium, iron, lead, and mercury. Additional characteristics unique to these elements are detailed below.

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