ARUP's Laboratory Test Directory

Heavy Metals Panel 3, Urine with Reflex to Arsenic Fractionated : 0099475

Mnemonic: HY MET U

Methodology: Quantitative Inductively Coupled Plasma-Mass Spectrometry
Performed: Mon-Sat
Reported: 1-4 days
Specimen Required: Patient Prep: Diet, medication, and nutritional supplements may introduce interfering substances. Patients should be encouraged to discontinue nutritional supplements, vitamins, minerals, non-essential over-the-counter medications (upon the advice of their physician), and avoid shellfish and seafood for 48 to 72 hours. High concentrations of iodine may interfere with elemental testing. Abstinence from iodine-containing medications or contrast agents for at least 1 month prior to collecting specimens for elemental testing is recommended.

Collect: 24-hour or random urine collection. Specimen must be collected in a plastic container and should be refrigerated during collection. ARUP studies indicate that refrigeration of urine alone, during and after collection, preserves specimens adequately if tested within 14 days of collection.

Specimen Preparation: Transfer 8 mL aliquot from a well-mixed collection to ARUP Trace Element-Free Transport Tubes (ARUP supply #43116). Available online through eSupply using ARUP Connect™ or contact ARUP Client Services at (800) 522-2787. (Min: 2 mL) Record total volume and collection time interval on transport tube and on test request form.

Storage/Transport Temperature: Refrigerated. Also acceptable: Room temperature or frozen.

Unacceptable Conditions: Urine collected within 48 hours after administration of a gadolinium (Gd) containing contrast media (may occur with MRI studies). Acid preserved urine.

Stability (collection to initiation of testing): Ambient: 1 week; Refrigerated: 2 weeks; Frozen: 1 year
Reference Interval:
 
Test Number Components Reference Interval
 Arsenic, Urine0-35.0 µg/L (based on Biological Exposure Index)
 Arsenic, Urine (24-hour)0-50.0 µg/d
 Arsenic per gram of creatinineNo reference interval (µg/g crt)
0020734Arsenic, Fractionated, Urine  
 
Test Number Components Reference Interval
 As Organic Refer to report
 Arsenic Total Inorganic Refer to report
 Arsenic, Methylated Refer to report
 Lead, Urine0-23 µg/L
 Lead, Urine (24-hour)0-31 µg/d
 Lead per gram of creatinineNo reference interval (µg/g crt)
 Mercury, Urine0-10 µg/L
 Mercury, Urine (24-hour)0-15 µg/d
 Mercury per gram of Creatinine Less than or equal to 35 µg/gCR
0020473Creatinine, 24-Hour Urine  
 
Age Male Female
3-8 years 140-700 mg/d 140-700 mg/d
9-12 years 300-1300 mg/d 300-1300 mg/d
13-17 years 500-2300 mg/d 400-1600 mg/d
18-50 years 1000-2500 mg/d 700-1600 mg/d
51-80 years 800-2100 mg/d 500-1400 mg/d
81 years and older 600-2000 mg/d 400-1300 mg/d

Interpretive Data: Specific toxic thresholds for arsenic are not well defined. The ACGIH Biological Exposure Index is 35 µg/L for the sum of the inorganic and methylated forms of arsenic. For specimens with a total arsenic concentration between 35-2000 µg/L, fractionation is performed to determine the proportion of organic, inorganic, and methylated forms. If low-level chronic poisoning is suspected, the µg/gCRT ratio may be more sensitive than the total arsenic concentration. It may be appropriate to fractionate specimens with a µg/gCRT ratio greater than 30 µg/gCRT despite a total arsenic concentration less than 35µg/L; the laboratory will perform this on request.

The organic forms of arsenic, most commonly arsenobetaine, are considered nontoxic and arise primarily from food. Inorganic forms of arsenic, As(III) and As(V), are most toxic. Methylated forms (MMA and DMA) arise primarily from metabolism of inorganic forms but may also come from dietary sources and are of moderate toxic potential. As this test does not detect all species of arsenic, it is expected that the sum of the organic, inorganic, and methylated forms will not equal the total arsenic concentration.
Note: If total arsenic concentration is between 35-2000 ug/L, then Arsenic, Fractionated, will be added to determine the proportion of organic, inorganic, and methylated forms. Additional charges apply.
CPT Code(s): 82175 Arsenic; 83655 Lead; 83825 Mercury; if reflexed, add 82175 Arsenic fractionated
Cross References: Arsenic (As) (Heavy Metals Panel 3, Urine with Reflex to Arsenic Fractionated), Lead (Pb) (Heavy Metals Panel 3, Urine with Reflex to Arsenic Fractionated), Mercury (Hg) (Heavy Metals Panel 3, Urine with Reflex to Arsenic Fractionated)
 
 

 

 

 
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