Arsenic, Random Urine with Reflex to Fractionated
Label Mnemonic: ARSUR
Epic code: LAB8527
Downtime form: A-1a Doctor/Provider Orders - Pathology Core and Specialty Care Nursery
Commercial Mail-out Laboratory
5231 RCP
356-8593
Specimen(s):
Random Urine
Specimen Instructions:
Patient Prep: 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. Collection of urine specimens from patients receiving iodinated or gadolinium-based contrast media should be avoided for a minimum of 72 hours post-exposure. Collection from patients with impaired kidney function should be avoided for a minimum of 14 days post contrast media exposure.
Collection Medium:
Urine (Random)-BD Vacutainer®, no additive yellow top
Minimum:
Preferred Minimum: 8 mL random urine
Absolute Minimum: 2 mL random urine
Rejection Criteria:
Acid preserved urine. Specimens collected within 72 hours after administration of iodinated or gadolinium-based contrast media.
Turn Around Time:
1-10 days upon receipt at reference laboratory
Reference Range:
Arsenic, Urine - per volume
   0.0-34.9 μg/L (based on Biological Exposure Index)

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
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 a total arsenic concentration of 35 to 2000 μg/L, fractionation is automatically performed to determine the proportions of inorganic, methylated and organic species. It may be appropriate to request fractionation for specimens with total arsenic greater than 30 μg/gCRT despite a total arsenic concentration less than 35 μg/L. If low-level chronic poisoning is suspected, the μg/gCRT ratio may be a more sensitive indicator of arsenic exposure than the total arsenic concentration.

Note: If total arsenic concentration is between 35-2000 μg/L, then Arsenic, Fractionated, will be added to determine the proportion of organic, inorganic, and methylated forms. Additional charges apply.
Methodology:
Quantitative High Performance Liquid Chromatography/Quantitative Inductively Coupled Plasma-Mass Spectrometry
CPT Code:
82175; if reflexed, add 82175