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Mercury Test: Procedure, Levels and Significance

A mercury test measures the concentration of mercury in blood, urine, or hair. It is used to diagnose mercury poisoning and to assess exposure to this toxic heavy metal.

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A mercury test measures the concentration of mercury in blood, urine, or hair. It is used to diagnose mercury poisoning and to assess exposure to this toxic heavy metal.

What Is a Mercury Test?

A mercury test is a diagnostic procedure that measures the concentration of mercury (Hg) in biological samples such as blood, urine, or hair. Mercury is a toxic heavy metal that exists in several forms: elemental mercury, inorganic mercury, and organic mercury (primarily methylmercury). Each form poses different health risks. The test is performed when elevated mercury exposure is suspected, for example through certain foods, occupational exposure, or dental amalgam fillings.

When Is a Mercury Test Performed?

A mercury test is indicated in the following situations:

Suspected acute or chronic mercury poisoning
Occupational exposure to mercury (e.g., in the chlor-alkali industry, mining, or dental professions)
Regular consumption of mercury-rich foods (e.g., tuna, swordfish, shark)
Neurological symptoms of unknown origin, such as tremors, memory problems, or numbness
Unexplained kidney dysfunction
Pregnancy with possible mercury exposure, as the unborn child is particularly vulnerable

Which Samples Are Tested?

Depending on the suspected type of exposure and the timing of the assessment, different biological samples may be analyzed:

Blood Sample

A blood test is best suited for detecting acute or recent mercury exposure. Methylmercury (organic form) binds to red blood cells and can be reliably measured in whole blood. The reference value for adults without special exposure is generally below 10 micrograms per liter (µg/L).

Urine Sample

A urine test is particularly useful for detecting exposure to inorganic or elemental mercury, such as from occupational settings or dental amalgam. Mercury is typically measured in a 24-hour urine collection or a spot urine sample. The reference value is generally below 7 µg/g creatinine.

Hair Sample

A hair analysis reflects long-term mercury exposure over the past several months, as mercury is incorporated into the hair shaft during growth. This method is especially suitable for detecting chronic methylmercury exposure, for example from regular fish consumption.

How Is the Test Performed?

Sample collection depends on the chosen test method:

Blood draw: A blood sample is collected from a vein and placed in a special metal-free tube to avoid contamination.
Urine collection: The patient collects urine over 24 hours in a special container, or provides a morning midstream urine sample.
Hair sample: A few centimeters of hair are cut as close to the scalp as possible and sent to the laboratory for analysis.

Laboratory analysis is typically performed using atomic absorption spectrometry (AAS) or inductively coupled plasma mass spectrometry (ICP-MS), both of which are highly sensitive methods for detecting heavy metals.

Interpreting the Results

Results must always be interpreted in the clinical context. Elevated mercury levels may indicate the following:

Mild elevation: High fish consumption or minor occupational exposure; usually no immediate symptoms
Moderate elevation: Possible early symptoms of mercury poisoning, such as fatigue, irritability, or mild coordination difficulties
Significantly elevated levels: Clear signs of poisoning requiring immediate medical attention

Note: Reference ranges may vary slightly between laboratories and measurement methods. Results should always be evaluated by a qualified healthcare professional.

Symptoms of Mercury Poisoning

Mercury poisoning can cause a wide range of symptoms depending on the type and duration of exposure:

Tremors of the hands or entire body
Memory problems and difficulty concentrating
Tingling or numbness in the hands and feet
Visual disturbances and narrowing of the visual field
Hearing impairment
Kidney dysfunction
Mood swings, anxiety, and depression
In children: developmental delays and neurological damage

Treatment for Elevated Mercury Levels

Treatment of mercury poisoning depends on the severity of the exposure:

Elimination of the source: The mercury source is identified and further exposure is stopped immediately.
Chelation therapy: In cases of clinically relevant poisoning, chelating agents such as DMSA (dimercaptosuccinic acid) or DMPS (dimercaptopropanesulfonic acid) may be administered. These substances bind mercury in the body and promote its excretion via the kidneys.
Supportive care: Symptomatic treatment to address kidney or neurological damage as needed.

References

World Health Organization (WHO): Mercury and Health. Fact Sheet, 2017. www.who.int
Agency for Toxic Substances and Disease Registry (ATSDR): Toxicological Profile for Mercury. U.S. Department of Health and Human Services, 2022. www.atsdr.cdc.gov
Clarkson TW, Magos L: The Toxicology of Mercury and Its Chemical Compounds. Critical Reviews in Toxicology, 2006; 36(8): 609-662.

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