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Epic Code LAB848 Nickel, Serum

Important Note

Order as Reference Miscellaneous #LAB848; indicate complete test name when ordering.

Additional Codes

Mayo Code: NIS

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Useful For

Confirmation of an elevated urinary nickel concentration

 

This test is not useful for the investigation of nickel hypersensitivity.

Specimen Type

Serum


Ordering Guidance


Urine is the preferred specimen type for determining nickel exposure and potential toxicity. Order NIU / Nickel, Urine or NICRU / Nickel/Creatinine Ratio, Random, Urine.

 

This test should not be ordered for the investigation of nickel hypersensitivity. Instead, order testing for lymphocyte proliferation to nickel.



Specimen Required


Patient Preparation: High concentrations of gadolinium and iodine are known to interfere with most metal tests. If either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for 96 hours.

Supplies: Metal Free Specimen Vial (T173)

Collection Container/Tube: Royal blue-top (metal-free, no additive)

Submission Container/Tube: 7-mL Mayo metal-free, screw-capped, vial

Specimen Volume: 2 mL

Collection Instructions:

1. Allow the specimen to clot for 30 minutes; then centrifuge the specimen to separate serum from the cellular fraction.

2. Remove the stopper. Carefully pour specimen into a Mayo metal-free, screw-capped vial, avoiding transfer of the cellular components of blood. Do not insert a pipet into the serum to accomplish transfer, and do not ream the specimen with a wooden stick to assist with serum transfer.

3. See Trace Metals Analysis Specimen Collection and Transport for complete instructions.


Laboratory Test Directory Note:

COLLECTION NOTE: Volumes listed are in serum or plasma, draw approximately 2 1/2 times the requested volume in whole blood.

Specimen Minimum Volume

0.5 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 7 days METAL FREE
  Ambient  7 days METAL FREE
  Frozen  7 days METAL FREE

Reject Due To

Gross hemolysis OK
Gross lipemia OK
Gross icterus OK

Cautions

This test cannot determine the source compound (eg, nickel sulfate) responsible for the exposure.

 

Specimen collection procedures for nickel require special collection containers, rigorous attention to ultraclean specimen collection and handling procedures, and analysis in an ultraclean facility. Unless all of these procedures are followed, increased urinary nickel results may be an incidental and misleading finding.

Clinical Information

Nickel (Ni) is a highly abundant element with a silvery-white appearance. Nickel is frequently combined with other metals to form alloys and is essential for the catalytic activity of some plant and bacterial enzymes (including in several pathogenic and symbiotic species in humans) but has no known role in humans.

 

Nickel and its compounds have no characteristic odor or taste. Ni compounds are used for Ni plating, to color ceramics, to make some batteries, and as substances known as catalysts that increase the rate of chemical reactions. One of the most toxic Ni compounds is nickel carbonyl, Ni(CO)4, which is used as a catalyst in petroleum refining and in the plastics industry, is frequently employed in the production of metal alloys such as stainless steel (which are popular for their anticorrosive and hardness properties), in nickel-cadmium rechargeable batteries, and is used as a catalyst in hydrogenation of oils. Ni(CO)4 is very toxic and is lipid-soluble, allowing it to cross cell membranes.

 

Occupational exposure to Ni occurs primarily via inhalation of Ni compounds. Inhalation of dust high in Ni content has been associated with development of lung and nasal cancer.

 

Food is the major source of exposure to Ni. Foods naturally high in Ni include chocolate, soybeans, nuts, and oatmeal. Individuals may also be exposed to nickel by breathing air, drinking water, or smoking tobacco containing Ni. Stainless steel and coins contain Ni. Some jewelry is plated with Ni or made from Ni alloys. Patients may be exposed to Ni in artificial body parts made from Ni-containing alloys.

 

The most common harmful health effect of Ni in humans is an allergic reaction. Approximately 10% to 20% of the population is sensitive to Ni. The most serious harmful health effects from exposure to Ni, such as chronic bronchitis, reduced lung function, and cancer of the lung and nasal sinus, have occurred in people who have breathed dust containing certain Ni compounds while working in Ni refineries or nickel-processing plants.

 

Urine is the specimen of choice for the determination of Ni exposure, but serum concentrations can be used to verify an elevated urine concentration.

 

Patients undergoing dialysis are exposed to Ni and accumulate Ni in blood and other organs; there appear to be no adverse health effects from this exposure. Hypernickelemia has been observed in patients undergoing kidney dialysis. At the present time, this is considered to be an incidental finding as no correlation with toxic events has been identified. Routine monitoring of patients undergoing dialysis is currently not recommended.

Method Name

Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)

Report Available

1 to 7 days

Reporting Name

Nickel, S

Reference Values

<2.0 ng/mL

Interpretation

Values 2.0 ng/mL and higher represent possible environmental or occupational exposure to nickel (Ni).

 

Toxic Ni concentrations are greater or equal to 10 ng/mL.

 

Normal Ni values are based on a Mayo Clinic study using healthy volunteers. Toxic values have been deduced from observation and unpublished internal study.

 

Clinical concern about Ni toxicity should be limited to patients with potential for exposure to toxic Ni compounds. Hypernickelemia, in the absence of exposure, may be an incidental finding or could be due to specimen contamination.

Method Description

This assay is performed on an inductively coupled plasma-mass spectrometer. Calibrating standards and blanks are diluted with an aqueous acidic diluent containing internal standards. Quality control specimens and patient samples are diluted in an identical manner. In turn, all diluted blanks, calibrating standards, quality control specimens, and patient specimens are aspirated into a pneumatic nebulizer and the resulting aerosol directed to the hot plasma discharge by a flow of argon. In the annular plasma the aerosol is vaporized, atomized, and then ionized. The ionized gases plus neutral species formed in the annular plasma space are aspirated from the plasma through an orifice into a quadrupole mass spectrometer. The mass range from 1 to 263 amu is rapidly scanned multiple times and ion counts tabulated for each mass of interest. Instrument response is defined by the linear relationship of analyte concentration vs. ion count ratio (analyte ion count/internal standard ion count). Analyte concentrations are derived by reading the ion count ratio for each mass of interest and determining the concentration from the response line.(Unpublished Mayo method)

Day(s) Performed

Thursday

Clinical Reference

1. Novelli EL, Rodrigues NL, Ribas BO: Superoxide radical and toxicity of environmental nickel exposure. Hum Exp Toxicol. 1995 Mar;14(3):248-251

2. Nixon DE, Moyer TP, Squillace DP, McCarthy JT: Determination of serum nickel by graphite furnace atomic absorption spectrometry with Zeeman-effect background correction: values in a normal population and a population undergoing dialysis. Analyst. 1989 Dec;114(12):1671-1674

3. US Department of Health and Human Services: Toxicological profile for nickel. Agency for Toxic Substances and Disease Registry. 2005 Accessed: March 2020. Available at: www.atsdr.cdc.gov/ToxProfiles/tp15.pdf

4. Rifai N, Horvath AR, Wittwer CT, eds: Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018

5. Zambelli B, Ciurli S: Nickel and human health. In: Sigel A, Sigel H, Sigel R, eds. Interrelations between Essential Metal Ions and Human Diseases. Metal Ions in Life Sciences. Vol 13. Springer, Dordrecht; 2013:321-357

Test Classification

This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

83885

LOINC Code Information

Test ID Test Order Name Order LOINC Value
NIS Nickel, S 5702-6

 

Result ID Test Result Name Result LOINC Value
8622 Nickel, S 5702-6
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