Arsenic
Label Mnemonic: ARSU
Epic code: LAB361
Downtime form: A-1a Doctor/Provider Orders - Pathology Core and Specialty Care Nursery
Commercial Mailout Laboratory
6240-8 RCP
356-8593
Specimen(s):
Specimen Instructions:
Refrigerate during 24 hr collection in plastic container.

Commercial laboratory studies indicate that refrigeration of urine alone, during and after collection, preserves specimen as well as any alternative preservatives added before collection, if specimen is tested within 14 days of collection.

Diet, medication, and nutritional supplements may introduce interfering substances. Patients should be encouraged to discontinue nutritional supplements, vitamins, minerals, nonessential over-the-counter medications (upon the advice of their physician), and avoid shellfish and seafood for 48 to 72 hours.

High concentrations of iodine may interfere with elemental testing. Abstinence from iodine-containing medications or contrast agents for at least 1 month prior to collecting specimens for elemental testing is recommended.
Collection Medium:
Urine - 24 hour/timed plastic urine container
Minimum:
Preferred Minimum: 8 mL urine from a well-mixed, refrigerated, 24 hr urine collection.
Absolute Minimum: 2 mL urine from a well-mixed, refrigerated, 24 hr urine collection.
Rejection Criteria:
Urine collected within 48 hours after administration of a gadolinium (Gd) containing contrast media (may occur with MRI studies). Acid preserved urine. Specimens contaminated with blood or fecal material. Specimens transported in non-trace element transport tube (with the exception of the original device).
Turn Around Time:
1-5 days upon receipt at reference laboratory
Reference Range:
Components                    Reference Interval
Arsenic, Urine-per volume     0.0-34.9 μg/L (based on Biological
                                 Exposure Index) 

Arsenic, Urine-per 24 hour    0.0-49.9 μg/d

Arsenic, Urine-ratio to CRT   0.0-29.9 μg/gCRT

Arsenic, Fractionated, Urine
  As Organic                  Refer to report
  Arsenic Total Inorganic     Refer to report
  Arsenic, Methylated         Refer to report

Creatinine(24 hour)           Male
                              3-8 years:  140-700 mg/d
                              9-12 years:  300-1300 mg/d
                              13-17 years:  500-2300 mg/d
                              18-50 years:  1000-2500 mg/d
                              51-80 years:  800-2100 mg/d
                              81 years and older:  600-2000 mg/d

                              Female
                              3-8 years:  140-700 mg/d
                              9-12 years:  300-1300 mg/d
                              13-17 years:  400-1600 mg/d
                              18-50 years:  700-1600 mg/d
                              51-80 years:  500-1400 mg/d
                              81 years and older:  400-1300 mg/d
Interpretive Data:
The ACGIH Biological Exposure Index (BEI) for arsenic in urine is 35 μg/L. The ACGIH BEI is based on the sum of inorganic and methylated species. For specimens with elevated total arsenic results, fractionation is automatically performed to determine the proportions of inorganic, methylated and organic species.

Per 24h calculations are provided to aid interpretation for collections with a duration of 24 hours and an average daily urine volume. For specimens with notable deviations in collection time or volume, ratios of analytes to a corresponding urine creatinine concentration may assist in result interpretation.

This test was developed and its performance characteristics determined by the reference laboratory. It has not been cleared or approved by the US Food and Drug Administration. This test was performed in a CLIA certified laboratory and is intended for clinical purposes.

Note: If total arsenic concentration is found to be elevated based on reference intervals, then Arsenic, Fractionated, will be added to determine the proportion of organic, inorganic, and methylated forms. Additional charges apply.
Comments:
To differentiate between organic and the more toxic inorganic forms, an arsenic speciation test is recommended and can be performed with the existing specimen by contacting the clinical laboratory lead scientist at pager 131-7283.

If urine, arsenic is abnormal, additional testing is performed by the reference laboratory. The patient will be charged for this testing when applicable.
Methodology:
Quantitative High Performance Liquid Chromatography/Quantitative Inductively Coupled Plasma-Mass Spectrometry
CPT Code:
82175; if reflexed, add 82175