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Investigation and monitoring of heavy metal poisoning
  1. Nicola L Barlow1,
  2. Sally M Bradberry2
  1. 1 Clinical Biochemistry, Black Country Pathology Services, West Bromwich, UK
  2. 2 West Midlands Poisons Unit, City Hospital, Birmingham, UK
  1. Correspondence to Dr Nicola L Barlow, Clinical Biochemistry, Black Country Pathology Services, West Bromwich B71 4HJ, UK; nicola.barlow1{at}


Historically, heavy metal measurement and interpretation has been a highly specialised area performed only in a handful of centres within the UK. However, recent years have seen a move to more local testing due to the repatriation of referred work into pathology networks and the increased availability of inductively coupled plasma mass spectrometry technology. While management of significant poisoning is still overseen by tertiary care poisoning specialists, management of milder cases may be undertaken locally.

Non-specialist clinical scientists and clinicians need to know when heavy metal testing is appropriate, which samples are required (and any specific requirements around collection) and how to interpret and act on the results.

This Best Practice article provides guidance on the investigation and monitoring of the toxic elements most frequently encountered in general medical practice; lead, mercury and arsenic. It is intended as a reference guide for the non-specialist and as a comprehensive summary for clinical toxicologists and clinical scientists.

  • chemistry, clinical
  • toxicology
  • biochemistry

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  • Handling editor Patrick J Twomey.

  • Contributors NLB conceived the article and wrote the initial synopsis. Thereafter, NLB and SMB contributed equally to review of the literature and preparation of the manuscript and both approved the final version to be published. NLB and SMB take equal responsibility for the overall content of the article as guarantors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests SMB is a member of the UKHSA Lead Exposure and Public Health Intervention and Surveillance (LEPHIS) Steering Group.

  • Provenance and peer review Commissioned; externally peer reviewed.