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?

Use table 2.



Remember that it is very easy for sample handling errors to lead to

lower numbers than are really there.



BTW, which lab did you have the test done at?



Andy



--- In Autism-Mercury@y..., john.gilfillan@a... wrote:

> 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?

Andy



Many thanks for your advice.



The lab is a pathology lab operating within the Royal Melbourne

Hospital which is in Melbourne, Australia.  This is the biggest

hospital in the city of Melbourne.  The test is recognised by the

medical authorities and is covered by the Government insurer in

Australia (Medicare).



I undertand that they mainly test for porphyria in adults and have

little knowlege of toxicology and porphyrins.  I have sent them

articles from the toxicology literature.



Can I ask you once again whether an increase in porphyrins is to be

expected from chelation and that an increase does not necessarily

mean you are damaging the liver.  My understanding is that increases

would need to be very high to cause one to stop chelation or lower

the chelating doses.





--- In Autism-Mercury@y..., AndyCutler@a... wrote:

> Use table 2.

>

> Remember that it is very easy for sample handling errors to lead to

> lower numbers than are really there.

>

> BTW, which lab did you have the test done at?

>

> Andy

>

> --- In Autism-Mercury@y..., john.gilfillan@a... wrote:

> > 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?