10 Assessment of trace element status

Biochemical and clinical investigations involving trace elements are made (1) for the diagnosis of inherited or acquired deficiencies of essential trace elements and their treatment, (2) to monitor the efficacy of the therapeutic administration of non-essential trace elements in order to achieve maximum clinical response with minimum toxicity, and (3) for the early detection of excessive ingestion of non-essential toxic trace elements.

The wide range of tests used to assess trace element status in these three areas of clinical importance is discussed with examples of essential and of toxic trace elements since therapeutic use of trace elements is discussed elsewhere in this issue. Particular attention is given to zinc, copper, selenium, lead and cadmium because the various tests used to assess the status of these elements encompass the principles of all currently available tests.

Although trace element analysis of body fluids and tissues is the most useful and most commonly used method of assessment of trace element status, this is of limited value and no single test may be considered as ideal for any element. The provision of more detailed information from elemental analysis of cellular and subcellular fractions and of protein fractions from plasma leads inexorably to measurements of element-dependent enzymes, metalloproteins and of low molecular weight element-binding ligands. Even at this level of discrimination the choice of body tissue or tissue fluid for investigation is determined by the trace element and its principal metabolic targets.