Heavy Metals Panel 3, Urine with Reflex to Arsenic Fractionated
0099475
 
Ordering Recommendation
Mnemonic
HY MET U
Methodology
Quantitative Inductively Coupled Plasma-Mass Spectrometry
Performed
Mon-Sat
Reported
1-4 days
New York DOH Approval Status
This test is New York DOH approved.
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
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.  
Remarks
 
Stability
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
Lead per gram of creatinineNo reference interval (µg/g crt)
Mercury, Urine -​ per 24h 0-​15 µg/L
Mercury, Urine -​ per volume 0-​10 µg/d
Mercury, Urine -​ ratio to CRT Less than or equal to 35 µg/gCR
0020473Creatinine, 24-​Hour Urine
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
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 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 for the sum of inorganic and methylated forms (species) of arsenic is 35 µg/L. For specimens with a total arsenic concentration between 35-2000 µg/L, fractionation is performed to determine the proportion of the inorganic, methylated, and organic forms. Inorganic forms of arsenic are most toxic. Methylated forms arise primarily from metabolism of inorganic forms but may also come from dietary sources and are of moderate toxic potential. The organic forms of arsenic are considered nontoxic and arise primarily from food. The sum of the inorganic, methylated, and organic forms of arsenic may be lower than the total arsenic level.

If low-level chronic poisoning is suspected, the µg/gCRT ratio may be more sensitive than the total arsenic concentration. It may be appropriate to fractionate specimens with a µg/gCRT ratio greater than 30 despite a total arsenic concentration less than 35 µg/L. Performed upon request.
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 Name
0020207Creatinine, Urine - per volume
0020208Creatinine, Urine - per 24h
0025001Arsenic Urine ug/L
0025002Arsenic Urine ug/day
0025051Mercury, Urine - per 24h
0025052Mercury, Urine - per volume
0025054Mercury, Urine - ratio to CRT
0025058Arsenic, Urine ug/gCRT
0025061Lead, Urine ug/day
0025062Lead, Urine ug/L
0025065Lead, Urine ug/gCRT
0097110Total Volume
0097111Hours Collected
* Component test codes cannot be used to order tests. The information provided here is not sufficient for interface builds; for a complete test mix, contact interface support at interface.support@aruplab.com.
Cross References
  • Arsenic
  • Hb
  • Lead
  • Mercury
  • Mercury concentation
  • Pb
  • Urine concentration
  • Urine AS
  • Urine AS concentration