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Arsenic (total), urine; arsenic (inorganic), urine; creatinine, urine; arsenic (inorganic):creatinine ratio; arsenic (total), urine (24-hour)
Monitor chronic exposure to arsenic
Total arsenic: inductively coupled plasma/mass spectrometry (ICP/MS); inorganic arsenic: flow injection atomic absorption spectrometry (FIAS)
• Environmental exposure: Total arsenic: 0−50 μg/L, 0−50 μg/24 hours; inorganic arsenic: <20 μg/L
• Occupational exposure: BEI®, inorganic arsenic plus methylated metabolites (sampling time is end of work week): 35 μg/L creatinine1
Arsenic poisoning of a chronic nature is often evidenced by cardiovascular abnormalities and neurological disorders. Acute exposures to high concentrations of arsenic may be evidenced by the following signs and symptoms:2
• Gastrointestinal: Severe abdominal pain, nausea and vomiting, bloody or rice-water diarrhea
• Cardiovascular and respiratory: Hypotension, shock, ventricular arrhythmia, congestive heart failure, pulmonary edema
• Neurologic: Lightheadedness, headache, weakness, lethargy, delirium, encephalopathy, convulsions, coma, sensorimotor peripheral neuropathy
• Hepatic and renal: Elevated liver enzymes, hematuria, oliguria, proteinuria, acute tubular necrosis, renal cortical necrosis
• Hematologic: Anemia, leukopenia, thrombocytopenia, disseminated intravascular coagulation
• Other: Rhabdomyolysis, garlic odor on breath, delayed appearance of Mees lines
In acute arsenic poisoning, death is usually due to cardiovascular collapse and hypovolemic shock.
Generally, inorganic arsenic is associated with industry and has a higher rate of toxicity than does the organic arsenic that is usually associated with dietary intake.3 Urine offers the better medium for analyzing a chronic or prolonged arsenic exposure. Possible dietary or domestic sources of arsenic should be considered if urine concentrations remain above the norm.
Arsenic compounds in organic forms have numerous commercial applications (eg, arsenical pesticides, pharmaceuticals, ceramic glass industry, and metallurgy). Arsine gas may also be emitted as a byproduct of certain industries, such as metallurgy. Organic forms of arsenic are typically encountered from dietary intake. BEI® are reference values intended as guidelines for evaluation of occupational exposure. BEI® represent biological levels of chemicals that correspond to workers with inhalation exposure equivalent to the threshold limit value (TLV®) of the chemicals. TLVs refer to the airborne concentrations of substances and represent conditions under which it is believed that nearly all workers may be repeatedly exposed, day after day, without adverse health effects.4
Urine (random or 24-hour)
Plastic urine container, no preservative
Patient must avoid all seafood for 72 hours prior to collection. Seafood consumption two to three days prior to specimen collection can markedly elevate levels of total arsenic in urine. This dietary form of arsenic is nontoxic and is comprised primarily of arsenobetaine and arsenocholine. Inorganic arsenic is used for industrial exposure monitoring.
Sampling time is the end of the work week for industrial exposure monitoring.
Metals with timing “end of work week” (meaning four or five consecutive working days with exposure) are eliminated with half-lives longer than five hours. Such metals accumulate in the body during the work week; therefore, their timing is critical in relation to previous exposures.
Optional protocol: Instruct the patient to void at 8 AM and discard the specimen. Then collect all urine including the final specimen voided at the end of the 24-hour collection period (ie, 8 AM the next morning). Avoid contact with metal during collection. Screw the lid on securely.
Maintain specimen at room temperature.
Request form must state volume collected as 24-hour, if applicable. Do not use preservative. Preservatives used for routine analysis may contain mercuric oxide (ie, Stabilur), which interferes with all metal testing. If both urinalysis and metal testing are ordered, please submit a separate urine specimen (no additive) for the metal testing.
|Order Code||Order Code Name||Order Loinc||Result Code||Result Code Name||UofM||Result LOINC|
|007039||Arsenic Exposure Profile, Ur||170391||Arsenic (Total),U||ug/L||21074-0|
|007039||Arsenic Exposure Profile, Ur||170392||Arsenic,Urine 24 Hr||ug/24 hr||5587-1|
|007039||Arsenic Exposure Profile, Ur||170394||Arsenic(Inorganic),U||ug/L||12481-8|
|007039||Arsenic Exposure Profile, Ur||723280||Creatinine(Crt),U||g/L||2161-8|
|007039||Arsenic Exposure Profile, Ur||170395||Inorg. As/Crt Ratio||ug/g creat||13825-5|