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

1-5 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 post -contrast media exposure.

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 72 hours after administration of iodinated or gadolinium-based contrast media. Acid preserved urine. Specimens contaminated with blood or fecal material. Specimens transported in non-trace element-free transport tube (with the exception of the original device).

Remarks
Stability

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

Reference Interval
Test Number
Components
Reference Interval
  Arsenic Urine - per volume Effective November 13, 2017
0.0-34.9 µg/L (based on Biological Exposure Index)
  Arsenic, Urine - ratio to CRT Effective November 13, 2017
0.0-29.9 ug/gCRT
0020734 Arsenic, Fractionated, Urine
Test Number Components
Reference Interval
  Arsenic, Organic Refer to report
  Arsenic, Inorganic Refer to report
  Arsenic, Methylated Refer to report

  Lead, Urine - ratio to CRT Effective November 12, 2018
0.0-5.0 ug/gCRT
  Lead, Urine - per volume Effective November 12, 2018
0.0-5.0 µg/L
  Mercury, Urine - per volume Effective November 12, 2018
0.0-5.0 µg/L
  Mercury, Urine - ratio to CRT Effective November 13, 2017
0.0-20.0 µg/gCRT

Interpretive Data

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

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.

Compliance Category

Standard

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.

Hotline History
N/A
CPT Codes

82175; 83655; 83825; if reflexed, add 82175

Components
Component Test Code* Component Chart Name LOINC
0020207 Creatinine, Urine - per volume 2161-8
0025001 Arsenic Urine - per volume 5586-3
0025052 Mercury, Urine - per volume 5689-5
0025054 Mercury, Urine - ratio to CRT 13465-0
0025058 Arsenic, Urine - ratio to CRT 13463-5
0025062 Lead, Urine - per volume 5676-2
0025065 Lead, Urine - ratio to CRT 13466-8
* 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
Heavy Metals Panel 3, Random Urine with Reflex to Arsenic Fractionated