Heavy Metals Urine with Reflex to Arsenic Fractionated Urine

Abbrev Code:UHM   
Order Code:LAB3834Order Name:Heavy Metals Urine with Reflex to Arsenic Fractionated Urine
Methodology:Inductively coupled plasma/mass spectrometry
CPT Codes: 82175 x1, 83655 x1, 83825 x1
Test Includes:Arsenic, lead, mercury.
Turnaround Time:Specimens are sent to reference laboratory Mon-Sat; results are reported in 1-5 days.

For tests developed and validated by ARUP (previously referred to as Compliance Statement B, C or D). This test was developed and its performance characteristics determined by ARUP Laboratories. It has not been cleared or approved by the U.S. Food and Drug Administration. This test was performed in a CLIA certified laboratory and is intended for clinical purposes.

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Urine Collection Procedure

Collection Instructions

Specimen:Urine, 24 hour or random collection
Optimal Volume:Submit entire 24 hour collection; analysis requires 2 mL
Container:3 L plastic jug
Alternate Containers: Plastic leakproof container, sterile
Collection Instructions:Specimen 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.
Patient Preparation:Diet, medication and nutritional supplements may introduce interfering substances. Patients should be encouraged to discontinue nutritional supplements, vitamins, mineral, nonessential over-the-counter medications (upon the advice of their physician) and avoid shellfish and seafood for 48 to 72 hours.
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.
Causes for Rejection:Specimen in contact with metal. Urine collected within 72 hours after administration of a gadolinium (Gd) containing contrast media (may occur with MRI studies). Specimens contaminated with blood or fecal material. Acid preserved urine. Specimens transported in containers other than specified.

Processing and Shipping

Specimen Processing:Mix collection well before aliquot is taken. Aliquot 8 mL, 2 mL minimum into 2 metal free plastic vials. Record total volume and collection duration on transport tube and request form. Store in refrigerator.
Shipping Instructions:Ship at refrigerated temperature.
Stability:1 week at room temperature, 2 weeks refrigerated, 1 year frozen.
Test Performed at or Referral Lab Lab Sendouts  (ARUP)
Referral Lab number:99475


Reference Range:
  µg/dL µg/d Per Gram of Creatinine
Arsenic 0-34.9 0-49.9 0-29.9 µg/gCRT
Lead 0.0-5.0 0-8.1 0.0-5.0 µg/gCRT
Mercury 0.0-5.0 0.0-20.0 0.0-20.00
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.
Specific toxic thresholds for arsenic are not well defined. The ACGIH Biological Exposure index is 35 µg/L for the sum of the inorganic and methylated forms of arsenic. For specimens with a total arsenic concentration between 35-2000 µg/L, fractionation is performed to determine the proportion of organic, inorganic and methylated forms. 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 µg/gCRT despite a total arsenic concentration less than 35 µg/L; the laboratory will perform this on request.
The organic forms of arsenic, most commonly arsenobetaine, are considered nontoxic and arise primarily from food, inorganic forms of arsenic As(III) and As(V), are the most toxic. Methylated forms (MA and DMA) arise primarily from metabolism of inorganic forms, but may also come from dietary sources and are of moderate toxic potential. As this test does not detect all species of arsenic it is expected that the sum of the organic, inorganic and methylated forms will not equal the total arsenic concentration.
If total arsenic concentration is between 35-2000 µg/L, Arsenic Fractional will be added to determine the proportion of organic, inorganic and methylated forms.  

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