Heavy Metals Panel 4, Urine with Reflex to Arsenic Fractionated
Ordering Recommendation
Quantitative Inductively Coupled Plasma-Mass Spectrometry
1-4 days  
New York DOH Approval Status
This test is New York DOH approved.
Submit With Order
Trace Elements Test Request Form Required (ARUP form #32990)Trace Elements Test Request Form Required (ARUP form #32990)

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) 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.  
Trace Elements requisition form may be required (ARUP form #32990-Barcode; #32991-No Barcode).  
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
 Mercury, Urine -​ per 24h 0-​15 µg/d
 Mercury, Urine -​ per volume 0-​10 µg/L
 Mercury, Urine -​ ratio to CRT Less than or equal to 35 µg/gCRT
 Creatinine, Urine -​ per 24h  
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
0025040Cadmium, Urine  
Test Number Components Reference Interval
 Cadmium, Urine -​ per volume Refer to report
 Cadmium, Urine -​ per 24h Refer to report
 Cadmium, Urine -​ ratio to CRT Refer to report
 Creatinine, Urine -​ per 24h Refer 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.  
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 volume20624-3
0020208Creatinine, Urine - per 24h2162-6
0025001Arsenic Urine - per volume21074-0
0025002Arsenic Urine - per 24h5587-1
0025038Cadmium, Urine - ratio to CRT13828-9
0025041Cadmium, Urine - per 24h5612-7
0025042Cadmium, Urine - per volume21130-0
0025051Mercury, Urine - per 24h6693-6
0025052Mercury, Urine - per volume21383-5
0025054Mercury, Urine - ratio to CRT26688-2
0025058Arsenic, Urine - ratio to CRT13824-8
0025061Lead, Urine - per 24h5677-0
0025062Lead, Urine - per volume20625-0
0025065Lead, Urine - ratio to CRT29943-8
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