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HelpTest Code ARSU / 007045-LC Arsenic Exposure Profile, Urine
Additional Codes
| Software | Test Code |
|---|---|
| SoftID | ARSU |
| EPIC | LAB20571 |
| LabCorp | 007045 |
Performing Laboratory
LabCorp - Laboratory Corporation of America (LCA)
Useful For
Monitor chronic exposure to arsenic.
Method Name
Inductively-coupled plasma-mass spectrometry (ICP-MS)
Reference Values
• 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
Report Available
3 - 6 days
Analytic time for send out tests is the time it will take to perform testing once it has arrived at the performing reference lab. Please add 1 to 2 days from time of collection to allow for receipt at NorDx central lab and shipment of specimen, add another day if specimen is collected on the day before a weekend or holiday.
Specimen Type
Urine (random or 24-hour)
Maintaining specimen at room temperature is preferred.
Preferred Container
Plastic urine container, no preservative
Preferred Volume
5 mL
Minimum Volume
2.5 mL (Note: This volume does not allow for repeat testing.)
Specimen Collection and Handling
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.
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.
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Refrigerated | 14 days | |
| Ambient | 14 days | |
| Frozen | 14 days |
Freeze/thaw cycles: Stable x3
CPT Code Information
| CPT Code | CPT Description | CPT Disclaimer |
|---|---|---|
| 82175 | Assay of arsenic | |
| 82570 | Assay of urine creatinine |
Clinical Significance
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.
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/References:
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).