Heavy Metals Panel 4, Blood
Ordering Recommendation
Quantitative Inductively Coupled Plasma-Mass Spectrometry
Mon, Wed-Sat
1-3 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 Collection and HandlingSpecimen Collection and Handling

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.  
Royal blue (K2EDTA or Na2EDTA).  
Specimen Preparation
Transport 7 mL whole blood. (Min: 1.5 mL)  
Storage/Transport Temperature
Room temperature. Also acceptable: Refrigerated.  
Unacceptable Conditions
Heparin anticoagulant. Frozen specimens.  
Trace Elements requisition form may be required (ARUP form #32990).  
Mercury is volatile; concentration may reduce after seven or more days of storage.  If the specimen is drawn and stored in the appropriate container, the arsenic, cadmium, and lead values do not change with time.  
Reference Interval
Test Number Components Reference Interval
0099045Arsenic, Blood 0.0-​13.0 µg/L
0099675Cadmium, Blood 0.0-​5.0 µg/L
0099305Mercury, Whole Blood 0-​10 µg/L
0020098Lead, Blood (Venous) 0.0-​4.9 µg/dL
Interpretive Data
Blood cadmium levels can be used to monitor acute toxicity and in combination with cadmium urine and B-2 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.

Information sources for reference intervals and interpretive comments include the "CDC Response to the 2012 Advisory Committee on Childhood Lead Poisoning Prevention Report" and the "Recommendations for Medical Management of Adult Lead Exposure, Environmental Health Perspectives, 2007." Thresholds and time intervals for retesting, medical evaluation, and response vary by state and regulatory body. Contact your State Department of Health and/or applicable regulatory agency for specific guidance on medical management recommendations.

Blood mercury levels predominantly reflect recent exposure and are most useful in the diagnosis of acute poisoning as blood mercury concentrations rise sharply and fall quickly over several days after ingestion. Blood concentrations in unexposed individuals rarely exceed 20 µg/L. The provided reference interval relates to inorganic mercury concentrations. Dietary and non-occupational exposure to organic mercury forms may contribute to an elevated total mercury result. Clinical presentation after toxic exposure to organic mercury may include dysarthria, ataxia and constricted vision fields with mercury blood concentrations from 20 to 50 µg/L.

Potentially toxic ranges for blood arsenic: Greater than or equal to 600 µg/L.

Blood arsenic is for the detection of recent exposure only. Blood arsenic levels in healthy subjects vary considerably with exposure to arsenic in the diet and the environment. A 24-hour urine arsenic is useful for the detection of chronic exposure.

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.
CPT Code(s)
82175; 82300; 83655; 83825
Component Test Code*Component Chart NameLOINC
0020098Lead, Blood (Venous)5671-3
0099045Arsenic Blood5583-0
0099305Mercury Blood5685-3
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.
  • Arsenic
  • AS blood level
  • Cadmium
  • Cd blood level
  • Heavy metals blood levels
  • Hg blood level
  • Lead
  • Mercury
  • Pb blood level