Which clinical history findings suggest heavy metal toxicity?

Updated: Dec 31, 2020
  • Author: Adefris Adal, MD, MS; Chief Editor: Sage W Wiener, MD  more...
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A history of exposure is the most critical aspect of diagnosing heavy metal toxicity. A complete history includes questions about potential occupational exposures, hobbies, recreational activities, and potential environmental exposure.

A complete dietary history should be taken, especially the ingestion of fish, seafood, and seaweed products since these will frequently be implicated as dietary sources of organic (and relatively nontoxic) mercury, arsenic, or both. The timing of ingestion relative to the collection of urine samples is critical to interpreting the results.

Herbal medications and dietary supplements are also potential sources of heavy metal exposure. Many Ayurvedic and Chinese patent medicines contain heavy metals.

Most acute presentations of heavy metal toxicity involve industrial exposure.

The ingestion of nonfood items such as paint chips, toys, and ballistic devices has also been implicated as the source of metal exposure in several cases.

Retained lead shot may ultimately lead to toxicity as well, although generally the shot must be bathed in relatively acidic body compartments such as the peritoneal fluid, pleural fluid, cerebrospinal fluid, or  synovial fluid for significant absorption of metal ions to occur.

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