Ordering Recommendation

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

HY MET U4

Methodology

Quantitative Inductively Coupled Plasma-Mass Spectrometry

Performed

Sun-Sat

Reported

1-5 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. Collection of urine specimens from patients receiving iodinated or gadolinium-based contrast media should be avoided for a minimum of 72 hours post-exposure. Collection from patients with impaired kidney function should be avoided for a minimum of 14 days postcontrast media exposure.

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)

Storage/Transport Temperature

Refrigerated. Also acceptable: Room temperature or frozen.

Unacceptable Conditions

Urine collected within 72 hours after administration of iodinated or gadolinium-based contrast media. Acid preserved urine. Specimens contaminated with blood or fecal material. Specimen 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-Barcode; #32991-No Barcode). Record total volume and collection time interval on transport tube and on test request form.

Stability

Ambient: 1 week; Refrigerated: 2 weeks; Frozen: 1 year

Reference Interval

Test Number
Components
Reference Interval
  Creatinine, Urine - per 24h
Age
Male (mg/d)
Female (mg/d)
3-8 years 140-700 140-700
9-12 years 300-1300 300-1300
13-17 years 500-2300 400-1600
18-50 years 1000-2500 700-1600
51-80 years 800-2100 500-1400
81 years and older 600-2000 400-1300

  Arsenic Urine - per volume 0.0-34.9 µg/L
  Arsenic Urine - per 24h 0.0-49.9 µg/d
  Cadmium, Urine - ratio to CRT 0.0-3.2 µg/g CRT
  Cadmium, Urine - per 24h 0.0-3.2 µg/d
  Cadmium, Urine - per volume 0.0-1.0 µg/L
  Mercury, Urine - per 24h 0.0-20.0 µg/d
  Mercury, Urine - per volume 0.0-5.0 µg/L
  Mercury, Urine - ratio to CRT 0.0-20.0 µg/g CRT
  Arsenic, Urine - ratio to CRT 0.0-29.9 µg/g CRT
  Lead, Urine - per 24h 0.0-8.1 µg/d
  Lead, Urine - per volume 0.0-5.0 µg/L
  Lead, Urine - ratio to CRT 0.0-5.0 µg/g CRT

Interpretive Data

Quantification of urine excretion rates before or after chelation therapy has been used as an indicator of lead exposure. Urinary excretion of >125 mg of lead per 24 hours is usually associated with related evidence of lead toxicity.

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 elevated total arsenic results, fractionation is automatically performed to determine the proportions of inorganic, methylated and organic species. 

Per 24h calculations are provided to aid interpretation for collections with a duration of 24 hours and an average daily urine volume. For specimens with notable deviations in collection time or volume, ratios of analytes to a corresponding urine creatinine concentration may assist in result interpretation.

This test was developed and its performance characteristics determined by ARUP Laboratories. It has not been cleared or approved by the US Food and Drug Administration. This test was performed in a CLIA certified laboratory and is intended for clinical purposes. 

Compliance Category

Laboratory Developed Test (LDT)

Note

If total arsenic concentration is found to be elevated based on reference intervals, then Arsenic, Fractionated, will be added to determine the proportion of organic, inorganic, and methylated forms. Additional charges apply.

Hotline History

N/A

CPT Codes

82175; 83655; 83825; 82300; if reflexed, add 82175

Components

Component Test Code* Component Chart Name LOINC
0020207 Creatinine, Urine - per volume 2161-8
0020208 Creatinine, Urine - per 24h 2162-6
0025001 Arsenic Urine - per volume 5586-3
0025002 Arsenic Urine - per 24h 5587-1
0025038 Cadmium, Urine - ratio to CRT 13828-9
0025041 Cadmium, Urine - per 24h 5612-7
0025042 Cadmium, Urine - per volume 5611-9
0025051 Mercury, Urine - per 24h 6693-6
0025052 Mercury, Urine - per volume 5689-5
0025054 Mercury, Urine - ratio to CRT 13465-0
0025058 Arsenic, Urine - ratio to CRT 13463-5
0025061 Lead, Urine - per 24h 5677-0
0025062 Lead, Urine - per volume 5676-2
0025065 Lead, Urine - ratio to CRT 13466-8
0097110 Total Volume 19153-6
0097111 Hours Collected 30211-7
* 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.

Aliases

  • Arsenic (As)
  • As
  • Cadmium (Cd)
  • Cd
  • Hg
  • Lead (Pb)
  • Mercury (Hg)
  • Metals Screen
  • Pb
  • Toxicology Quantitative Screen, Metals
Heavy Metals Panel 4, Urine with Reflex to Arsenic Fractionated