Arsenic Exposure Profile, Urine

CPT: 82175; 82570
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Synonyms

  • As, Urine

Test Includes

Arsenic (total), urine, with reflex to Arsenic, Toxic species if total arsenic is >=10 ug/L; arsenic (total), urine (24-hour); creatinine, urine; arsenic (total):creatinine ratio


Special Instructions

Request form must state volume collected as 24-hour, if applicable. Do not use preservatives. 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.


Expected Turnaround Time

3 - 6 days



Related Documents


Specimen Requirements


Specimen

Urine (random or 24-hour)


Volume

5 mL


Minimum Volume

2.5 mL (Note: This volume does not allow for repeat testing.)


Container

Plastic urine container, no preservative


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


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.


Test Details


Use

Monitor chronic exposure to arsenic


Limitations

This test was developed and its performance characteristics determined by Labcorp. It has not been cleared or approved by the Food and Drug Administration.


Methodology

Inductively-coupled plasma-mass spectrometry (ICP-MS)


Reference Interval

Environmental exposure: Total arsenic: 0−9 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: Light-headedness, 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. Biological Exposure Indices (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


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, FL: 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
007045 Arsenic Exposure Profile, Ur 96253-0 170391 Arsenic (Total),U ug/L 5586-3
007045 Arsenic Exposure Profile, Ur 96253-0 170392 Arsenic,Urine 24 Hr ug/24 hr 5587-1
007045 Arsenic Exposure Profile, Ur 96253-0 723280 Creatinine(Crt),U g/L 2161-8
007045 Arsenic Exposure Profile, Ur 96253-0 007067 As (Total)/Crt Ratio ug/g creat 13463-5
Reflex Table for Arsenic (Total),U
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 007056 ARSENIC, Toxic Species, URINE 007057 Arsenic, Inorganic ug/L 12481-8
Reflex Table for Arsenic (Total),U
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 007056 ARSENIC, Toxic Species, URINE 007058 Arsenic, MMA ug/L 94458-7
Reflex Table for Arsenic (Total),U
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 007056 ARSENIC, Toxic Species, URINE 007059 Arsenic, DMA ug/L 94457-9
Reflex Table for Arsenic (Total),U
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 007056 ARSENIC, Toxic Species, URINE 007060 Arsenic, Total Toxic ug/L 96251-4
Reflex Table for Arsenic (Total),U
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 007056 ARSENIC, Toxic Species, URINE 007061 Please Note: N/A

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