Doc, can you test me for "toxic metals"? Challenges of testing for toxicants in patients with environmental concerns

Laboratory testing is an important tool to assist clinicians in evaluation of patients with potential environmentally-related illness, however, it can be challenging to select or interpret the appropriate toxicological tests. Recent advances in analytical techniques and expanded consumer access to environmental laboratories led to a rise in laboratory testing for various environmental toxicants, including metals. However, most environmental tests have scant clinical evidence and are not validated for clinical use. While the tests themselves may not present direct harm to the patients, the results of inappropriately selected tests may lead to significant patient stress and unnecessary follow-up or treatment. Given the lack of environmental health content in medical training, pediatricians may feel ill-equipped to address most environmental issues they encounter in practice, including the interpretation of environmental toxicant lab results. This article provides an overview of how to approach a child and family with environmental health concerns about "toxic metals", select appropriate metal tests if indicated, and enlist the assistance of the Pediatric Environmental Health Specialty Units (PEHSU) for further management guidance.