Heavy metal chelation tests: the misleading and hazardous promise
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GUEST EDITORIAL
Heavy metal chelation tests: the misleading and hazardous promise Perrine Hoet1 · Vincent Haufroid1,2 · Dominique Lison1 Received: 22 June 2020 / Accepted: 9 July 2020 / Published online: 16 July 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Heavy metal screening is currently very popular, especially on the web, and has become a “must do” for an increasing number of patients. The relative availability of inductively coupled plasma mass spectrometry equipments capable of measuring multiple elements at once has boosted the diffusion of these practices. In most cases, the list of elements measured in these screens reflects the analytical capacity of the lab more than sound toxicological considerations. These “urine mobilization tests”, “post-chelator challenges”, “provocative chelations”, “chelation challenges”, or “challenge tests” (hereafter called “provocative chelation test” [PCT]) represent an appreciable business. The screen almost systematically reveals “heavy metal poisoning”, and “detox cures” are generally recommended. As academic toxicologists, we are increasingly consulted by patients anxious about their recent diagnosis of heavy metal poisoning based on the results of an overpriced PCT. Patients with vague and lingering complaints, without a clear diagnosis, who have often consulted several physicians are perfect targets for this business. In the short-term, these patients are often relieved to hear that someone has found a clue to their complex medical condition, and they enthusiastically undertake successive chelation cures. An example, among others. Recently, the Belgian Federal Agency for Occupational Risks received a claim for recognizing and compensating neuropathic disorders caused by heavy metals as an occupational disease. The patient was on sick leave for more than 3 years, and though his general condition progressively worsened, he developed several manifestations, including a mild sensitive peripheral neuropathy. Blood and urine were collected in the absence of chelation and analyzed by a laboratory with successful * Dominique Lison [email protected] 1
Louvain Center for Toxicology and Applied Pharmacology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
Laboratory of Analytical Biochemistry, Cliniques Universitaires Saint-Luc, Brussels, Belgium
2
results in external quality assessments. The results were within the reference values for the general population (lead, 23 µg/L blood, 0·66 µg/L urine; mercury,
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