2nd order laboratory parameters – depending on the results of the medical history, physical examination, etc. – for differential diagnostic clarification
- Small blood count
- Differential blood count
- Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate).
- Urine status (rapid test for: pH, leukocytes, nitrite, protein, glucose, ketone, urobilinogen, bilirubin, blood), sediment, if necessary urine culture (pathogen detection and resistogram, that is, testing suitable antibiotics for sensitivity / resistance).
- Liver parameters – alanine aminotransferase (ALT, GPT), aspartate aminotransferase (AST, GOT), glutamate dehydrogenase (GLDH), gamma-glutamyl transferase (γ-GT, gamma-GT; GGT), alkaline phosphatase, bilirubin.
- Renal parameters – urea, creatinine, cystatin C if necessary.
- Allergy tests
- Determination of porphyrins, delta-aminolevulinic acid and porphobilinogen (PBG) in 24h collection urine – due toporphyria or acute intermittent porphyria (AIP) (disorders of porphyrin and bilirubin metabolism).
- Ethylbenzene in the blood – exposure to aromatic hydrocarbons in the workplace.
- Tetrachloroethene (chlorinated hydrocarbon) – due topossible exposure to tetrachloroethene.
- Toluene (useful is joint determination with: benzene, ethylenebenzene and xylene) – highly volatile aromatic hydrocarbon; belongs to the “BTXE2 group” (benzene-toluene-xylene-ethylbenzene) Toluene is used in paints, varnishes, polishes, adhesives and paint removal; it is a component of gasoline (exposure to car traffic) and is more neurotoxic than benzene.
- Trichloroacetic acid in urine – formed by metabolizing various chlorinated hydrocarbons (trichloroethaene, trichloroethane, tetrachloroethene and others) in the liver; with a half-life in the blood of circa 2 to 3 days and excretion via the kidney
- Hippuric acid in the urine – metabolite of toluene and is excreted in the urine when toluene exposure.
- Phenol in urine – phenol exposure and intoxication associated with benzene (phenol is metabolite of benzene).
- Formic acid in urine – degradation product of formaldehyde.
- DMPS test (dimaval test) – due todetection of heavy metals DMPS (2,3-dimercapto-1-propanesulfonate) binds as a chelating agent in the body extracellular heavy metals in water-soluble compartments. Excretion is then predominantly renal. Determined in urine: creatinine, mercury, zinc, tin, selenium, copper, cadmium and lead Implementation: 1. 20-50 ml spontaneous urine (urine I), 2. completely empty the bladder, 3. 300 mg DMPS orally with 300 ml water, 4. after 4 hours 20-50 ml spontaneous urine (urine II).
