I am confused about interpreting my 4 year old's porphyrin results.
We have been chelating (DMSA + ALA) since September last year and
have had his porphyrins checked 3 times - a baseline figure for
August 2000 and 2 subsequent tests.

Table 1 shows one way of presenting the results.

Aug 2000 Nov 2000 Mar 2001 Ref range
Creatinine
(mmol/l) 4.7 L 2.0 L 11.2 5-20
Total porphyrins
(nmol/l) 184 148 502 High 0-300
Porph/creat 39 H 74 H 45 High 0-35
Uroporphyrin
(nmol/l) 22 18 40 0-40
Coproporphyrin
(nmol/l) 162 H 127 452 High 0-150
…copro I
(nmol/l) 24 16 70 0-105
…copro III
(nmol/l) 138 111 387 High 0-240

L = Low H = High reference ranges for adults


The lab commented that urine collections and results in August and
November 2000 were not reliable because the creatinine levels were
too low - ie below the (adult?) reference range. Just recently, for
the March 2001 results, I purposely collected urine first thing in
the morning to try and get the creatinine level up to "normal".
They were prepared this time to confirm that the liver is under some
disturbance.

I presume that a toxic individual will show elevated porphyrins both
before and while chelating. This table seems to show some toxicity
before chelating (August 2000) – slightly elevated coproporhyrins -
and then a reduction in toxicity (in November 2000) and then a major
increase in coprporphyrins 6 months into the chelation (March 2001) –
well over the upper limit of the reference range.

Is this normal with chelation? I take it that some increase in
coproporhyrins to levels above normal is to be expected as the metals
are sequested from the brain and elsewhere and transported to the
liver for excretion. I presume the trick is to ensure that the liver
is not being over-taxed. Do these porphyrin levels indicate that the
liver is being over-taxed? Can porphyrin levels provide an
indication of the how well the chelation is going and whether it
should be modified – too high an increase implies that less chelation
is needed and vice-versa?

Table 2 shows another way of presenting the same data but which
suggests a different interpretation. This table calculates
porphyrins per unit of creatinine using the data from Table 1.

Aug 2000 Nov 2000 Mar 2001 Ref
range
Uroporphyrin
(umol/mol creatinine) 4.7 8.9 3.6 0-5.7
Coproporphyrin
(umol/mol creatinine 34.5 63.5 High 40.4 0-46
…copro I
(umol/mol creatinine 5.1 8.1 6.3 0-10.3
…copro III
(umol/mol creatinine 29.4 55.5 High 34.6 0-35.7

The reference ranges are drawn from the article referred to by Andy
in the "Files" section and are for 4 year olds.

Using this methodology shows a baseline coproporhyrin (August 2000)
measure which is above average but nor above the reference range and
then a major increase in coproporhryins (implying greater toxicity
while chelating in November 2000) and then a reduction to a level
below the upper limit in March 2001 but still above the baseline
figure.

I don't know which interpretation to rely upon nor whether the
chelation therapy is going OK.

Can Andy or anyone who has experience with porphyrin tests while
chelating help with this?