Ordering Recommendations

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).

Orderable SIM Number(s)

HEAVY METALS SCREEN, URINE (LAB398)

Synonyms

  • Heavy Metals Screen, Urine
  • Urine concentration
  • Hb
  • Urine AS
  • Pb
  • Arsenic
  • Urine AS concentration
  • Lead
  • Mercury concentation
  • Mercury
  • Mercury concentration
  • LAB398

ARUP Test Code

0099475

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

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. Specimens transported in non-trace element-free transport tube (with the exception of the original device).

Stability (from collection to initiation)

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

Special Handling Instructions

**CRITICAL** Trace element processing required. Sample needs to be in a blue-capped ARUP Trace Element-Free Transport Tube.

Please fill out and send the following form along with the specimen; see link below.

http://ltd.aruplab.com/api/ltd/pdf/6

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.

Reference Interval

Components
Reference Interval
Creatinine, Urine - per 24h
Age
Male (mg/d)
Female (mg/d)
3-8 years140-700140-700
9-12 years300-1300300-1300
13-17 years500-2300400-1600
18-50 years1000-2500700-1600
51-80 years800-2100500-1400
81 years and older600-2000400-1300

Arsenic Urine - per volume0.0-34.9 µg/L
Arsenic Urine - per 24h0.0-49.9 µg/d
Mercury, Urine - per 24h0.0-20.0 µg/d
Mercury, Urine - per volume0.0-5.0 µg/L
Mercury, Urine - ratio to CRT0.0-20.0 µg/g CRT
Arsenic, Urine - ratio to CRT0.0-29.9 µg/g CRT
Lead, Urine - per 24h0.0-8.1 µg/d
Lead, Urine - per volume0.0-5.0 µg/L
Lead, Urine - ratio to CRT0.0-5.0 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.

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.

Notes

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.

CPT Codes

82175; 83655; 83825; if reflexed, add 82175

Billable SIM Number(s)

332761, 332763

3018217501 (CPT 82175)

LOINC

  • 2161-8
  • 2162-6
  • 5586-3
  • 5587-1
  • 6693-6
  • 5689-5
  • 13465-0
  • 13463-5
  • 5677-0
  • 5676-2
  • 13466-8
  • 19153-6
  • 30211-7
Overview

Ordering Recommendations

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).

Orderable SIM Number(s)

HEAVY METALS SCREEN, URINE (LAB398)

Synonyms

  • Heavy Metals Screen, Urine
  • Urine concentration
  • Hb
  • Urine AS
  • Pb
  • Arsenic
  • Urine AS concentration
  • Lead
  • Mercury concentation
  • Mercury
  • Mercury concentration
  • LAB398

ARUP Test Code

0099475
Specimen

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

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. Specimens transported in non-trace element-free transport tube (with the exception of the original device).

Stability (from collection to initiation)

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

Special Handling Instructions

**CRITICAL** Trace element processing required. Sample needs to be in a blue-capped ARUP Trace Element-Free Transport Tube.

Please fill out and send the following form along with the specimen; see link below.

http://ltd.aruplab.com/api/ltd/pdf/6

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.
Interpretive

Reference Interval

Components
Reference Interval
Creatinine, Urine - per 24h
Age
Male (mg/d)
Female (mg/d)
3-8 years140-700140-700
9-12 years300-1300300-1300
13-17 years500-2300400-1600
18-50 years1000-2500700-1600
51-80 years800-2100500-1400
81 years and older600-2000400-1300

Arsenic Urine - per volume0.0-34.9 µg/L
Arsenic Urine - per 24h0.0-49.9 µg/d
Mercury, Urine - per 24h0.0-20.0 µg/d
Mercury, Urine - per volume0.0-5.0 µg/L
Mercury, Urine - ratio to CRT0.0-20.0 µg/g CRT
Arsenic, Urine - ratio to CRT0.0-29.9 µg/g CRT
Lead, Urine - per 24h0.0-8.1 µg/d
Lead, Urine - per volume0.0-5.0 µg/L
Lead, Urine - ratio to CRT0.0-5.0 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.

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.

Notes

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.
Coding

CPT Codes

82175; 83655; 83825; if reflexed, add 82175

Billable SIM Number(s)

332761, 332763

3018217501 (CPT 82175)

LOINC

  • 2161-8
  • 2162-6
  • 5586-3
  • 5587-1
  • 6693-6
  • 5689-5
  • 13465-0
  • 13463-5
  • 5677-0
  • 5676-2
  • 13466-8
  • 19153-6
  • 30211-7

Performed

Performed
Sun-Sat

Reported/Turnaround Time

Reported

3-6 days

Methodology

Methodology
Quantitative Inductively Coupled Plasma-Mass Spectrometry

Orderable SIM Number

Orderable SIM Number(s)

HEAVY METALS SCREEN, URINE (LAB398)

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