Feedback
Cadmium Exposure Panel - OSHA
0025013
Ordering Recommendation

Recommended for occupation exposure monitoring. This panel includes cadmium in blood and urine as well as beta-2-microglobulin and provides exposure guidance in accordance with OSHA regulations. To assess cadmium exposure in a non-occupational setting, Cadmium, Urine (0025040) and/or Cadmium, Blood (0099675) are preferred.

Mnemonic
CD EXP
Methodology
Cadmium, Urine & Blood: Quantitative Inductively Coupled Plasma-Mass Spectrometry
Creatinine, Urine: Spectrophotometry
Beta-2 Microglobulin Urine: Chemiluminescent Immunoassay
Performed
Mon-Fri
Reported
1-5 days
New York DOH Approval Status
This test is New York DOH approved.
Submit With Order
Specimen Required
Patient Preparation
To avoid contamination, please collect specimens at the beginning of work shift. Blood and urine should be collected the same day. 
Collect
Royal blue (K2EDTA or Na2EDTA) AND minimum 40 mL urine using spot technique (single void) in an open-top urine collection cup. 
Specimen Preparation
Transfer specimens to the appropriate transport device using the Cadmium exposure kit, ARUP supply #16450, available online through eSupply using ARUP Connect™ or by contacting ARUP Client Services at (800) 522-2787.
Blood: Transport 7 mL whole blood. (Min: 0.5 mL)
Urine for β 2 Microglobulin:
Transfer 3 mL aliquot from original urine collection to an ARUP Standard Transport Tube. Adjust the pH of this specimen immediately after pouring off collection, so the pH is between 6 and 8. Use 1M HCl or 5 percent NaOH to adjust the urine pH. Label tube as β2 Microglobulin. Freeze within one hour of collection.
Urine for Cadmium:
Transfer 7 mL aliquot from original urine collection to ARUP Trace Element-Free Transport Tubes (ARUP supply #43116). Available online through eSupply using ARUP Connect™ or by contacting ARUP Client Services at (800) 522-2787. (Min: 0.5 mL) Label tube as Cadmium.
Urine for Creatinine: Transfer 2 mL aliquot from original urine collection to an ARUP Standard Transport Tube. (Min: 0.5 mL) Label tube as Creatinine. 
Storage/Transport Temperature
Blood: Refrigerated.

Urine for β 2 Microglobulin: Frozen
Urine for Cadmium:
Refrigerated.
Urine for Creatinine:
Refrigerated. 
Unacceptable Conditions
Urine collected within 48 hours after administration of a gadolinium (Gd) containing contrast media (may occur with MRI studies).  Urine containing blood or fecal materials. Samples transported in non-trace element free transport tube (with the exception of the original device). 
Remarks
Trace Elements requisition form may be required (ARUP form #32990).  
Stability
Refer to individual components. 
Reference Interval
Test Number
Components
Reference Interval
0099675Cadmium, Blood0.0-5.0 µg/L
 Cadmium, Urine - per volume0.0-2.6 µg/L
 Creatinine, Urine - per volumeNo reference interval
 Cadmium, Urine - ratio to CRT0.0-3.0 µg/g CRT
 Beta-2-Microglobulin, UrineEffective February 18, 2014
0-300 µg/L
 Beta-2-Microglobulin, ratio to CRT0-300 µg/g CRT

Interpretive Data
Blood cadmium levels can be used to monitor acute toxicity and in combination with cadmium urine and β2 microglobulin is the preferred method for monitoring occupational exposure. 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.

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.

Urine β2 Microglobulin is an early marker of irreversible kidney damage and disease.
Urine creatinine values less than 20 mg/dL represent very dilute urine and collections should be repeated.

CADMIUM ACTION LEVELS BEGINNING JANUARY 1999 (Federal Register 1999, Std. CFR, Part 1910. 1027 Appendix A)
Components
A
B
C
Cadmium, Urine (µg/g CRT)≤ 3>3 to ≤ 7>7
Cadmium, Blood (µg/L)0-5>5 to ≤ 10>10
β2 Microglobulin, Urine (µg/g CRT)≤ 300>300 to ≤ 750>750*
MonitorAnnualSemiannualQuarterly
Medical ExamBiennialAnnualSemiannual
Reassess Cadmium exposure in less than two weeks---------DiscretionaryMandatory removal
*If an employee's β2 Microglobulin level is above 750 µg/g CRT, in order for mandatory medical removal to be required, either the employee's CdU level must also be >3 µg/g CRT or CdB level must also be >5 µg/L.

The determination of discretionary or mandatory removal is made by the examining physician consistent with the medical surveillance specifications in the Federal Register 42456 to 42463.

References:
1. US Department of Labor (2004). Cadmium. Occupational Safety and Health Administration. 3136-06R.
2. US Department of Labor (1999). Cadmium. Occupational Safety and Health Standards. 1910.1027



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.

Note
CPT Code(s)
82300 x2; 82232; 82570
Components
Component Test Code*Component Chart NameLOINC
0020207Creatinine, Urine - per volume2161-8
0025039Cadmium, Urine - ratio to CRT13471-8
0025042Cadmium, Urine - per volume5611-9
0080052Beta-2-Microglobulin, ratio to CRT13485-8
0080270pH, Urine2756-5
0080435Beta-2-Microglobulin, Urine1953-9
0099675Cadmium, Blood5609-3
* 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.
Aliases
  • blood cadmium concentration
  • blood cadmium level
  • cadmium level
  • Cd