81440:ARSENIC (As), QUANTITATIVE, 24 HOUR URINE

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81440:ARSENIC (As), QUANTITATIVE, 24 HOUR URINE
Methodology: Inductively Coupled Plasma/Mass Spectrometry (ICP/MS / High Pressure Liquid Chromatography (HPLC)
Edit Date: 6/11/2010
Performed: Monday-Friday
Released: 1-5 days after setup at PeaceHealth Laboratories’ reference lab
CPT Code: 82175-90 / x2 if reflexed
Specimen Collection Details
Collection: 24-hour urine or random urine collected in a clean, dry plastic container (non-colored preferred). Refrigerate during collection, handling, and transport. NOTE: Patient should abstain from shellfish and seafood for 48-72 hours prior to collection.
Handling: Mix well and aliquot into two ARUP Trace Element-Free transport tubes, available from PeaceHealth Laboratories Client Services. Record total volume and collection time interval on tubes, or container, and requisition. Refrigerate.

Studies indicate the refrigeration alone of urine during and after collection preserves specimen as well as preservatives if tested with 14 days of collection.

Stability: 7 days ambient, 14 days refrigerated, or 1 year frozen.
Standard Volume: 10 mL urine aliquot.
Minimum Volume: 5 mL urine aliquot.
Transport: Refrigerated.
Comments: If the Arsenic, UR is >35.0 µg/L, the test automatically reflexes to an Arsenic Fractionated, UR. A speciation is performed to differentiate between organic, inorganic, and methylated arsenic.
Rejection Criteria: Urine collected within 48 hours after administration of a gadolinium (Gd) containing contrast media (may occur with MRI studies); acid preserved urine.

Reference Interval:
Arsenic, Urine 0-35.0 µg/L
Arsenic, Urine (24-hour) 0-50.0 µg/d
Arsenic per gram of Creatinine No reference interval
Creatinine (24-hour) Age Male Female
3-8 years 140-700 mg/d 140-700 mg/d
9-12 years 300-1300 mg/d 300-1300 mg/d
13-17 years 500-2300 mg/d 400-1600 mg/d
18-50 years 1000-2500 mg/d 700-1600 mg/d
51-80 years 800-2100 mg/d 500-1400 mg/d
>80 years 600-2000 mg/d 400-1300 mg/d
Intrepretative Date: Specific toxic thresholds for arsenic are not well defined. The ACGIH Biological Exposure Index is 35 µg/L for the sum of the inorganic and methylated forms of arsenic. For specimens with a total arsenic concentration between 35-20000 µg/L, fractionation is performed to determine the proportion or organic, inorganic and methylated forms. If low=level chronic poisoning is suspected, the µg/gCRT ration may be more sensitive than the total arsenic concentration. It may be appropriate to fractionate specimens with a µg/gCRT ratio >30 µg/gCRT despite a total arsenic concentration 35 µg/L; the laboratory will perform this on request.

The organic forms of arsenic, most commonly arsenobetaine, are considered nontoxic and arise primarily from food. Inorganic forms of arsenic [As(III) and As(V)] are most toxic. Methylated forms (MMA and DMA) arise primarily from metabolism of inorganic forms but may also come from dietary sources and are of moderate toxic potential. As this test does not detect all species of arsenic, it is expected that the sum of the organic, inorganic, and methylated forms will not equal the total arsenic concentration.