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Heavy Metals Panel 3, Random Urine with Reflex to Arsenic Fractionated
2011304
Ordering Recommendation

Useful in the assessment of acute and chronic exposure to arsenic, 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).

Mnemonic
HYMETU RND
Methodology
Quantitative Inductively Coupled Plasma-Mass Spectrometry
Performed
Sun-Sat
Reported
1-4 days
New York DOH Approval Status
This test is New York DOH approved.
ARUP Consult®
Disease Topics
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. 
Collect
Random urine. 
Specimen Preparation
Transfer an 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. 
Remarks
 
Stability
Ambient: 1 week; Refrigerated: 2 weeks; Frozen: 1 year 
Reference Interval
Test Number
Components
Reference Interval
 Arsenic Urine - per volume0-35.0 µg/L (based on Biological Exposure Index)
 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 volume0-23 µg/L
 Mercury, Urine - per volume0-10 µg/L
 Mercury, Urine - ratio to CRTLess than or equal to 35 µg/gCRT

Interpretive Data
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 tremors. 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 of 35 to 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.

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; 83655; 83825; if reflexed, add 82175
Components
Component Test Code*Component Chart NameLOINC
0020207Creatinine, Urine - per volume2161-8
0025001Arsenic Urine - per volume5586-3
0025052Mercury, Urine - per volume5689-5
0025054Mercury, Urine - ratio to CRT13465-0
0025058Arsenic, Urine - ratio to CRT13463-5
0025062Lead, Urine - per volume5676-2
0025065Lead, Urine - ratio to CRT13466-8
* 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
  • Arsenic
  • Hb
  • Lead
  • Mercury
  • Mercury concentation
  • Pb
  • Urine AS
  • Urine AS concentration
  • Urine concentration