Antimony High

This individual's urine antimony (Sb) is higher than expected, but potential associated symptoms and toxic effects may not be present. This is because antimony has two valences: Sb+3 and Sb+5. Sb+3 is inherently the more toxic but is mostly excreted in feces. Sb+5, less toxic, binds less well to body tissues and is excreted mostly in urine. The current analysis does not differentiate the two forms of Sb.

Antimony can be assimilated by inhalation of Sb salt or oxide dust, ingested with (contaminated) foods or fluids, or absorbed transdermally. Inhalation may occur in industrial areas that involve smelting or alloying is done (usually with copper, silver, lead, tin). Sb is present in tobacco at about 0.01% by weight; about 20% of this is typically inhaled by cigarette smoking (Carson et al., Toxicology and Biological Monitoring of Metals in Humans, Lewis Pub. p. 21, 1987). Antimony compounds are used for fireproofing textiles and plastics, and this element may be found in battery electrodes, ceramics and pigments. Antimony can be absorbed with the handling of gun powder or the frequent use of firearms. Recent studies indicate high levels of antimony in sheepskin bedding produced in New Zealand. Antimony contamination of soft plastic-bottled water is time and temperature dependent.

Symptoms of mild Sb exposure/retention may be insidious and multiple including: fatigue, muscle weakness, myopathy, and metallic taste. Chlorides and oxides of both valences of Sb can be mutagenic and may affect leukocyte function. Sb can bond to sulfhydryl (-SH) sites on enzymes and may interfere with cellular metabolism. Acute symptoms that may be associated with excessive Sb exposure/retention include: respiratory tissue irritation and pneumoconiosis with (chronic) inhalation of Sb dusts, RBC hemolysis with inhalation of stibine (SbH3) vapor, and gastrointestinal distress if orally ingested. Skin exposure can produce "antimony spots" or rashes which resemble chicken pox. Certain molds can produce the highly neurotoxic stibine gas from Sb, stibine inhibits acetylcholinestelase activity.

A hair element analysis may be used to further assess Sb exposure. Antimony may be elevated in urine following administration of DMPS or DMSA if exposures to Sb have resulted in net retention; such levels may or may not be associated with overt adverse health effects.

Lead High

This individual's urine lead (Pb) is higher than expected which means that Pb exposure is higher than that of the general population. A percentage of assimilated Pb is excreted in urine. Therefore the urine Pb level reflects recent or ongoing exposure to Pb and the degree of excretion or endogenous detoxification processes.

Sources of Pb include: old lead-based paints, batteries, industrial smelting and alloying, some types of solders, Ayruvedic herbs, some toys and products from China and Mexico, glazes on (foreign) ceramics, leaded (anti-knock compound) fuels, bullets and fishing sinkers, artist paints with Pb pigments, and leaded joints in municipal water systems. Most Pb contamination occurs via oral ingestion of contaminated food or water or by children mouthing or eating Pb-containing substances. The degree of absorption of oral Pb depends upon stomach contents (empty stomach increases uptake) and upon the essential element intake and Pb status. Deficiency of zinc, calcium or iron increases Pb uptake. Transdermal exposure is significant for Pb-acetate (hair blackening Products). Inhalation has decreased significantly with almost universal use of non-leaded automobile fuel.

Excessive Pb exposure can be assessed by comparing urine Pb levels before and after provocation with CA-EDTA (iv) or oral DMSA. Urine Pb is higher post-provocation to some extent in almost everyone. Whole blood analysis reflects only recent ongoing exposure and does not correlate well with total body retention of Pb. However, elevated blood Pb is the standard of care for diagnosis of Pb poisoning (toxicity).