Mercury Tri-Test

Quicksilver Scientific’s CLIA-certified laboratory specializes in advanced mercury speciation testing, using the patented Mercury Tri-Test. This test utilizes samples of hair, blood, and urine to assess for the body’s mercury burden and its ability to eliminate it. This test helps practitioners and patients to understand the magnitude and source of mercury exposure, as well as if additional support is needed in the process of mercury detoxification.

The Quicksilver Mercury Tri-Test is the only clinical test that utilizes mercury speciation analysis, a patented advanced technology that separates methyl mercury (MeHg) from inorganic mercury (HgII) and measures each directly. Quicksilver Scientific’s instruments are sensitive enough to measure ambient mercury levels in the body WITHOUT THE NEED FOR CHALLENGE TESTING. This laboratory test provides unprecedented information for healthcare practitioners, allowing them to assess the patient’s exposure sources, body burden and ability to excrete each form of mercury. This detailed information helps build an informed picture and allows the clinician to plan a rational approach to a successful detoxification strategy for the patient.

 

What about Mercury Challenge Testing?

 

In the 1990’s, sensitivity of analytical equipment was not advanced enough to measure ambient (steady state) blood mercury levels. Therefore, “challenge” or “provocation” testing, using high doses of strong chelation agents, was developed to “pull” mercury out of organic cellular structure for urinary analysis under the diagnostic premise that it shows the mercury “body burden” of an individual and establishes correlation of long-term mercury burden. While mercury challenge testing was clinically relevant for the time, advances in technology and clinical study have proven challenge testing to be unreliable and even potentially damaging to the patient.

 

Does the "challenge test" really show the "body burden" of mercury?

 

Problems associated with challenge testing include:

 

  1. Challenge Test does not differentiate between MeHg and Hgll. Only Total mercury level is represented (HgT).
  2. Challenge does not reflect the “pool” of mercury premise.
  3. There is no “non-challenged” reference range to compare the challenge test to; from a regulatory standpoint, there is an obvious potential for over-treatment.
  4. Lack of standardization of challenge conditions:
    1. Challenge does not reflect long-term exposure as proven by clinical trial* reference p.120.
    2. Challenge does not reflect long-term exposure as proven by clinical trial* reference.
      1. DMPS has a very different strength and specificity than DMSA.
      2. IV vs. oral administration has vastly different pharmacokinetics.
      3. Use of adjuncts such as EDTA, glutathione and glycine vastly changes the dynamics of the test and its output.
  1. Challenge exposes individual to large dose of exogenous substance.
  2. Challenge may cause redistribution of mercury into organs, including the brain.
  3. Challenge does not measure ambient mercury burden.
  4. Challenge does not elucidate elimination abilities of patient.
  5. Challenge results are skewed in individuals with renal insufficiency (common in Hgll toxicity).

 

 

Here are some examples where competing mercury testing technologies fail to reveal complexities that the Quicksilver Tri-Test can:

 

Test Example 1: False Negative:

 

Patient consumes little or no fish meals and has dental amalgams. (Patient levels indicated by blue bars and squares.)

 

 

 

Explanation: MeHg typically shows a greater than a one decimal place order of magnitude compared to Hgll in ambient blood levels. In single, unspeciated blood, urine, hair and challenge testing, MeHg level overshadows Hgll level that may be at high, possibly toxic levels.

 

Competing testing technologies will show the following:

 

Blood HgT: Low. This test missed it! Patient is not excreting more highly toxic Hgll, but the MeHg level is very low, causing overall mercury level determination to fall below a level that would indicate the patient has a problem. (MeHg typically exhibits a greater than one decimal place greater concentration in ambient blood level.) ADDITIONALLY, a blood total mercury test alone would not reveal that the patient is not excreting Hgll anywhere near an optimum level, and is therefore accumulating Hgll.

 

Urine THg: Low: This test missed it! Urinary excretion is principal route of Hgll elimination. Patient is not eliminating, so urine test will not reveal meaningful information about mercury burden of patient.

 

Hair: Low: Missed it! Hair predominantly measures MeHg excretion, and patient has low MeHg level.

 

Challenge: Low: Missed it! Challenge test fails to detect proper level of HgT due to severely compromised kidney function in this patient.


Test Example 2: Potential False Positives:

 

Patient consumes high amount of fish meals and has no dental amalgams. (Patient levels indicated by blue bars and squares.)

 

Explanation: For equal body burden MeHg is typically 10–15 times higher than Hgll in ambient blood levels, due to different tissue:blood partitioning. Potential false positive created by HIGH MeHg and low Hgll.

 

Competing testing technologies will show the following:

 

Blood HgT: High: False positive created by HIGH MeHg and low Hgll.

 

Urine: Low: This test may correctly identify the patient as low Hg burden due to low Hgll level.

 

Hair: High: Patient is efficiently excreting MeHg, and test may falsely cause alarm to practitioner.

 

Challenge: High: Challenge testing incorrectly shows high in this patient due to efficient kidney function and elimination.

 

 

Test Example 3: Patient is demethylating MeHg: (Patient levels indicated by blue bars and squares.)

 

Patient has very high fish consumption and no dental amalgams. The overburden of MeHg is being de-methylated to Hgll, and driving Hgll levels up. Additionally, patient has depressed kidney function causing Hgll to be accumulated. This is a high-risk scenario.

 

 

Competing testing technologies will show the following:

 

Blood HgT: High: Though this test will show high burden, it will not be able to decipher the source of exposure or the distribution into each pool.

 

Urine: There is a chance this test will fail to determine high mercury burden due to very compromised kidney function, and certainly will not be able to decipher the source of exposure, or the most obvious remedy.

 

Hair: High: Though this test will likely show high burden, it will not show the extent of inorganic mercury accumulation due to demethylation.

 

Challenge: There is a chance this test will fail to determine high mercury burden due to very compromised kidney function, and it certainly will not be able to decipher the source of exposure.

 

 

What is Mercury Speciation Analysis?

Mercury speciation is an analytical testing process that separates and measures the different forms (species) of mercury that are present in a test sample. Quicksilver Scientific holds the exclusive license on a patented cold vapor mercury analysis technology that is automated and scalable. This makes our method of mercury speciation analysis an easy and cost-effective solution for processing large test-sample batch sizes.

 

Why Use Mercury Speciation?

 

In a single test, Quicksilver Scientific speciation analysis measures the biologically available forms of mercury (methylmercury and inorganic mercury). This is why our mercury test is superior to conventional "total" mercury analysis. Rather than simply delivering an undifferentiated lump-sum total, Quicksilver Scientific speciation of mercury provides useful data on the ratio of methylmercury to inorganic mercury. In addition to this, the patented Quicksilver mercury measurement process can be expanded to include rare forms of this toxic element (ethylmercury and propylmercury).

 

Our mercury speciation analysis gives researchers and physicians access to critical data unavailable from competitive low-level mercury analysis methods (total mercury analysis). Understanding the ratio of methylmercury to inorganic mercury facilitates a more complete understanding of toxic effects and risks to the environment and the human body.

 

Currently, Quicksilver Scientific is the only commercial analytical testing laboratory capable of directly analyzing ethylmercury, methylmercury and inorganic mercury in one simultaneous procedure at environmentally and biologically relevant amounts.

 

More Resources

Why our mercury testing is different. Click Here

 

How the mercury tri-test and blood metals panel differ. Click Here

 

Learn more about mercury. Click Here

 

Mercury 101 webinar. Click Here