Arsenic Exposure Profile, Urine

CPT: 82175; 82570
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Test Details

Test Includes

Arsenic (total), urine; arsenic (inorganic), urine; creatinine, urine; arsenic (inorganic):creatinine ratio; arsenic (total), urine (24-hour)

Use

Monitor chronic exposure to arsenic

Methodology

Total arsenic: inductively coupled plasma/mass spectrometry (ICP/MS); inorganic arsenic: flow injection atomic absorption spectrometry (FIAS)

Reference Interval

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

Additional Information

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

Specimen Requirements

Specimen

Urine (random or 24-hour)

Volume

5 mL

Minimum Volume

2.5 mL

Container

Plastic urine container, no preservative

Patient Preparation

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.

Collection

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.

Storage Instructions

Maintain specimen at room temperature.

Stability Requirements

Temperature

Period

Room temperature

14 days

Refrigerated

14 days

Frozen

14 days

Freeze/thaw cycles

Stable x3

Clinical Information

Special Instructions

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.

Footnotes

1. BEI® (Biological Exposure Indices) based on 2010 Recommendations of the American Conference of Governmental Industrial Hygienists (ACGIH).
2. US Department of Health and Human Services, Agency for Toxic Substances and Disease Registry. Arsenic toxicity. Case Studies in Environmental Medicine. 2000. Course: SS3060.
3. Tsalev DL, Zaprianov ZK, Atomic Absorption Spectrometry in Occupational and Environmental Health Practice. Boca Raton, Fla: CRC Press;1983-1984.
4. TLVs and BEIs, Threshold Limit Values for Chemical Substances and Physical Agents and Biological Exposure Indices 2010. American Conference of Governmental Industrial Hygienists (ACGIH).

LOINC® Map

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

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The LOINC® codes are copyright © 1994-2018, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee. Permission is granted in perpetuity, without payment of license fees or royalties, to use, copy, or distribute the LOINC® codes for any commercial or non-commercial purpose, subject to the terms under the license agreement found at https://loinc.org/license/. Additional information regarding LOINC® codes can be found at LOINC.org, including the LOINC Manual, which can be downloaded at LOINC.org/downloads/files/LOINCManual.pdf