Heavy Metals Panel 4, Urine with Reflex to Arsenic Fractionated
Ordering Recommendation

Useful in the assessment of acute and chronic exposure to arsenic, cadmium, mercury, and lead. The preferred test for the assessment of lead exposure is Lead, Blood (Venous) (0020098). For occupational exposure, consider Lead, Industrial Exposure Panel, Adults (0025016) and/or Cadmium Exposure Panel - OSHA (0025013).

Quantitative Inductively Coupled Plasma-Mass Spectrometry
1-4 days
New York DOH Approval Status
This test is New York DOH approved.
Submit With Order
Specimen Required
Patient Preparation
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. 
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) 
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. Specimens contaminated with blood or fecal material. Specimen transported in non-trace element-free transport tube (with the exception of the original device). 
Trace Elements requisition form may be required (ARUP form #32990-Barcode; #32991-No Barcode). Record total volume and collection time interval on transport tube and on test request form. 
Ambient: 1 week; Refrigerated: 2 weeks; Frozen: 1 year 
Reference Interval
Effective May 18, 2015
Test Number
Reference Interval
 Arsenic Urine - per volume0-35.0 µg/L (based on Biological Exposure Index)
 Arsenic Urine - per 24h0-50.0 µg/d
 Arsenic, Urine - ratio to CRTLess than 30 ug/gCRT
0020734Arsenic, Fractionated, Urine
Test NumberComponents
Reference Interval
 Arsenic, OrganicRefer to report
 Arsenic, InorganicRefer to report
 Arsenic, MethylatedRefer to report

 Lead, Urine - ratio to CRTLess than 5 ug/gCRT
 Lead, Urine - per 24h0-31 µg/d
 Lead, Urine - per volume0-23 µg/L
 Mercury, Urine - per 24h0-15 µg/d
 Mercury, Urine - per volume0-10 µg/L
 Mercury, Urine - ratio to CRTLess than or equal to 35 µg/gCRT
 Creatinine, Urine - per 24h
3-8 years140-700 mg/d140-700 mg/d
9-12 years300-1300 mg/d300-1300 mg/d
13-17 years500-2300 mg/d400-1600 mg/d
18-50 years1000-2500 mg/d700-1600 mg/d
51-80 years800-2100 mg/d500-1400 mg/d
81 years and older600-2000 mg/d400-1300 mg/d

0025040Cadmium, Urine
Test Number
Reference Interval
 Cadmium, Urine - per volumeRefer to report
 Cadmium, Urine - per 24hRefer to report
 Cadmium, Urine - ratio to CRTRefer to report
 Creatinine, Urine - per 24hRefer to report

Interpretive Data
Urine cadmium levels can be used to assess cadmium body burden. In chronic exposures, the kidneys are the primary target organ. Symptoms associated with cadmium toxicity vary based upon route of exposure and may include tubular proteinuria, fever, headache, dyspnea, chest pain, conjunctivitis, rhinitis, sore throat and cough. Ingestion of cadmium in high concentration may cause vomiting, diarrhea, salivation, cramps, and abdominal pain.

Urinary mercury levels predominantly reflect acute or chronic elemental or inorganic mercury exposure. Urine concentrations in unexposed individuals are typically less than 10 µg/L. 24 hour urine concentrations of 30 to 100 µg/L may be associated with subclinical neuropsychiatric symptoms and tremor while concentrations greater than 100 µg/L can be associated with overt neuropsychiatric disturbances and tremors. Urine mercury levels may be useful in monitoring chelation therapy.

The ACGIH Biological Exposure Index (BEI) for arsenic in urine is 35 µg/L. The ACGIH BEI is based on the sum of inorganic and methylated species. For specimens with a total arsenic concentration between 35-2000 µg/L, fractionation is automatically performed to determine the proportions of inorganic, methylated and organic species. It may be appropriate to request fractionation for specimens with a total arsenic greater than 30 µg/gCRT despite a total arsenic concentration less than 35 µg/L. If low-level chronic poisoning is suspected, the µg/gCRT ratio may be a more sensitive indicator of arsenic exposure than the total arsenic concentration.

Compliance Statement B: This test was developed and its performance characteristics determined by ARUP Laboratories. The U.S. Food and Drug Administration has not approved or cleared this test; however, FDA clearance or approval is not currently required for clinical use. The results are not intended to be used as the sole means for clinical diagnosis or patient management decisions.

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; 83655; 83825; 82300; if reflexed, add 82175
Component Test Code*Component Chart NameLOINC
0020207Creatinine, Urine - per volume2161-8
0020208Creatinine, Urine - per 24h2162-6
0025001Arsenic Urine - per volume5586-3
0025002Arsenic Urine - per 24h5587-1
0025038Cadmium, Urine - ratio to CRT13828-9
0025041Cadmium, Urine - per 24h5612-7
0025042Cadmium, Urine - per volume5611-9
0025051Mercury, Urine - per 24h6693-6
0025052Mercury, Urine - per volume5689-5
0025054Mercury, Urine - ratio to CRT13465-0
0025058Arsenic, Urine - ratio to CRT13463-5
0025061Lead, Urine - per 24h5677-0
0025062Lead, Urine - per volume5676-2
0025065Lead, Urine - ratio to CRT13466-8
0097110Total Volume19153-6
0097111Hours Collected30211-7
* Component test codes cannot be used to order tests. The information provided here is not sufficient for interface builds; for a complete test mix, please click the sidebar link to access the Interface Map.
  • Arsenic (As)
  • As
  • Cadmium (Cd)
  • Cd
  • Hg
  • Lead (Pb)
  • Mercury (Hg)
  • Metals Screen
  • Pb
  • Toxicology Quantitative Screen, Metals