Prescription binding drugs substantially lower blood lead; sweating and nutrients shift smaller amounts. Whether that lowering buys better health is unsettled — kidney findings come from one research group, heart-disease results conflict, and removing lead did not restore thinking in exposed children. The drugs strip zinc, copper and calcium, and some products sold for detoxification contain lead, mercury or arsenic. (Full Review)
| Marker | Target | Why |
|---|---|---|
| Whole-blood lead | Below 1.0 µg/dL | Primary target and best-validated metal marker |
| Whole-blood mercury | Below 3.0 µg/L | Distinguishes recent dietary from stored inorganic mercury |
| Urine cadmium | Below 0.5 µg/g creatinine | Reflects lifetime kidney accumulation, unlike blood cadmium |
| Urine arsenic, speciated | Inorganic plus methylated species below 10 µg/L | Separates toxic inorganic arsenic from seafood arsenobetaine |
| eGFR | Above 90 mL/min/1.73 m² | Sets the safe chelator dose and detects tubular injury |
| Urine albumin-to-creatinine ratio | Below 10 mg/g | Detects early glomerular injury from metal or chelator |
| Ionised calcium | 1.16–1.31 mmol/L | Most important safety marker, given fatal chelation hypocalcaemia |
| Plasma zinc | 90–120 µg/dL | The essential mineral most heavily stripped by chelators |
| Serum copper | 80–110 µg/dL | Depleted alongside zinc; shows up later as anaemia |
| Red-cell magnesium | 5.0–6.5 mg/dL | Serum magnesium misses depletion; red-cell tracks stores |
| Neutrophil count | Above 2.0 × 10⁹/L | Succimer causes occasional neutropenia during oral courses |
| Alanine aminotransferase | Below 25 U/L in men, below 20 U/L in women | Succimer raises liver enzymes more often than EDTA |
Cadence: Baseline panel before any course; creatinine and calcium weekly during infusions; blood count and liver enzymes at day fourteen of an oral course; target metal four to six weeks after finishing, then six- to twelve-monthly while exposure persists.