Chronic exposure to a metal (cadmium, arsenic, mercury, chromium): biomonitoring in the community
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Cadmium (recognised polluted soil, tobacco, past occupational exposure)
Morning urine (avoid offal and shellfish for the previous 3 days)
- Urinary cadmium, expressed in µg/g of creatinine
- Blood cadmium (if urinary cadmium raised)if neededBlood cadmium reflects recent exposure (3 to 6 months); tobacco raises it [2]. The NABM makes it a complementary test to a raised urinary cadmium [3].
- Urinary beta-2-microglobulin (if urinary cadmium > 2 µg/g of creatinine; second morning voiding, buffered sample)if neededAbove 2 µg/g creatinine of urinary cadmium, ANSES recommends monitoring early markers of tubulopathy (urinary RBP and beta-2-microglobulin), to be compared with their reference value of 250 µg/g creatinine; beta-2-microglobulin degrades in acid urine [2].
- Serum creatinine with eGFR
Do not order
- Urinary metallothioneins: still in the realm of research [2].
Arsenic (well water, naturally rich soil, treated wood, arsenical pesticides)
Urine (no seafood for the previous 48 to 72 hours)
- Urinary arsenic with speciation: inorganic arsenic + monomethylarsonic and dimethylarsinic acids (iAs + MMA + DMA), in µg/g of creatinine
Do not order
- Total urinary arsenic: not recommended, it includes organic arsenic of dietary origin (seafood) [2].
- Arsenic in hair or nails: not recommended routinely (wide variation between individuals, possible external contamination); forensic value only [2].
- Blood arsenic: little used outside acute poisoning; correlation with exposure not established [2].
Mercury (metallic mercury vapour; high consumption of predatory fish)
Laboratory tests
- Urinary mercury, preferably in the morning (metallic or inorganic mercury), in µg/g of creatinine
- Total blood mercury (exposure to methylmercury, heavy fish consumer, or fluctuating exposure)if neededWhole-blood mercury is the best indicator of exposure to organic mercury; fish consumption (tuna, swordfish) must be taken into account [2].
Chromium (chrome plating, welding, cement, tanning)
Urine
- Urinary chromium, in µg/g of creatinine
Lead
Laboratory tests
- Blood lead
- Full tests, management and notification: see the page "Saturnisme".
Do not order
- EDTA-provoked urinary lead in the community: a test not free of danger (rapid redistribution of lead that can worsen or reveal neurological and renal complications if chelation treatment does not follow), reserved for specialist centres [2].
- Spontaneous urinary lead: poor indicator of exposure and internal dose [2].
Sources (11)
- Santé publique France. Exposition aux métaux de la population française : résultats de l'étude Esteban. Communiqué de presse, 1er juillet 2021.
- Institut national de recherche et de sécurité (INRS). Base de données Biotox : collection intégrale des fiches (cadmium et composés minéraux, arsenic et composés inorganiques, mercure et composés, chrome et chromates, plomb et composés). Avril 2023.
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : actes 1692 et 1693 (cadmium), 0565 (plombémie), 0321 (bêta-2-microglobuline hors sang), 0627 (créatininurie).
- Société française de médecine du travail (avec la Société française de toxicologie analytique et la Société de toxicologie clinique). Surveillance biologique des expositions professionnelles aux agents chimiques. Recommandations de bonne pratique, texte court, mai 2016.
- INRS. Biotox : questions-réponses (« Quelle pertinence de l'ajustement à la créatinine pour les résultats de dosages urinaires ? »). Mise à jour de décembre 2017.
- Occupational Safety and Health Administration (OSHA, États-Unis). Occupational Safety and Health Standards, 29 CFR 1910.1027 : Cadmium (norme du 14 septembre 1992, amendée, texte en vigueur), paragraphes (l)(1) à (l)(3) sur la surveillance médicale.
- UK Health Security Agency (UKHSA). Cadmium: toxicological overview. Compendium of chemical hazards, mise à jour du 25 octobre 2024.
- Umweltbundesamt (UBA, Allemagne), Kommission Human-Biomonitoring. Reference and HBM values (page des valeurs d'évaluation ; page allemande « Beurteilungswerte der HBM-Kommission » mise à jour le 22 septembre 2026).
- UK Health Security Agency (UKHSA). Arsenic: toxicological overview. Compendium of chemical hazards, mise à jour du 15 octobre 2024.
- UK Health Security Agency (UKHSA). Elemental mercury and inorganic mercury: toxicological overview. Compendium of chemical hazards, mise à jour du 16 avril 2025.
- Occupational Safety and Health Administration (OSHA, États-Unis). Occupational Safety and Health Standards, 29 CFR 1910.1026 : Chromium (VI) (norme du 28 février 2006, amendée, texte en vigueur), paragraphe (k) sur la surveillance médicale.