Heavy Metals, Urine

Cleveland HeartLab H, Test

NEW YORK DOH APPROVED: YES
CPT Code: 82175 (x1), 83655 (x1), 83825 (x1)
Order Code: C2737
Includes: Creatinine per volume, Creatinine per 24 hour, Arsenic (µg/L), Arsenic (µg/day), Arsenic (µg/g CRT), Mercury (µg/L), Mercury (µg/day), Mercury (µg/g CRT), Lead (µg/L), Lead (µg/day), Lead (µg/g CRT)
ABN Requirement: No
Synonyms: Toxic Metals, Urine
Specimen: Urine (random or 24-hour, well-mixed)
Volume:  8.0 mL
Minimum Volume:  2.0 mL
Container: Urine (Yellow top, no preservative) tube

Collection:

Urine:

  1. Collect and label urine sample according to standard protocols.
  2. Transfer urine from a clean urine cup into a Yellow Top tube using the vacutainer transfer device included with the Yellow Top tube.
  3. Cap tube tightly.
  4. Label sample according to standard protocols.

24-Hour Urine:

  1. Collect and label urine sample according to standard protocols. Make note of total urine volume and include total volume on the requisition form.
  2. Mix 24-hour urine collection well. Transfer urine into a yellow top tube using disposable pipette.
  3. Cap tube tightly.
  4. Label sample according to standard protocols.

Required Information: Type of urine collection (random urine or 24-hour urine [including collection volume]) MUST be written on the requisition form when ordering this test.

Patient Preparation: Diet, medication, and nutritional supplements may introduce interfering substances. Patients should be encouraged to discontinue nutritional supplements, vitamins, minerals, nonessential over-the-counter medications, and avoid shellfish and seafood for 48-72 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. Urine specimens collected within 72 hours after administration of iodinated or gadolinium-based contrast media are not acceptable.

Special Information: Specimens with a total arsenic concentration between 35-2000 ug/L will have Arsenic Fractionated, Organic; Arsenic, Inorganic; and Arsenic Methyl performed at an additional charge (CPT 82175) to determine the proportion of organic, inorganic, and methylated forms of arsenic present. Urine collected within 48 hours after administration of gadolinium (Gd) containing contrast media are not acceptable. Acid preserved urine, specimens contaminated with blood or fecal material, and specimens transported in non-trace element-free transport tubes (with the exception of the original device) are unacceptable. Studies indicate that refrigeration of urine alone, during, and after collection preserves specimens adequately if tested within 14 days of collection.

Transport: Store urine at 2-8°C after collection and ship the same day per packaging instructions provided with the Cleveland HeartLab shipping box.

Stability:

Ambient (15-25°C): 7 days
Refrigerated (2-8°C):
14 days
Frozen (-20°C):
1 year
Deep Frozen (-70°C):
1 year

Causes for Rejection: Specimens other than urine without preservatives; improper labeling; samples not stored properly; samples older than stability limits; specimens collected within 48 hours after administration of gadolinium (Gd) containing contrast media

Methodology: ICP/Mass Spectrometry

Turn Around Time: 3-6 days

Reference Range:

ComponentAgeNormal Range
Arsenic – per volume (µg/L)All Ages0.0-34.9 µg/L
(based on Biological Exposure Index)
Arsenic – per 24 hours (µg/day)All Ages0.0-49.9 µg/day
Arsenic – ratio to CRT (µg/g CRT)All Ages0.0-29.9 µg/g CRT
Mercury, Urine - per volumeAll Ages0.0-5.0 µg/L
Mercury, Urine - per 24 hoursAll Ages0.0-20.0 µg/day
Mercury, Urine - ratio to creatinineAll Ages0.0-20.0 µg/g CRT
Lead – ratio to creatinine (µg/g CRT)All Ages0.0-5.0 µg/g CRT
Lead – per 24 hours (µg/day)All Ages0.0-8.1 µg/day
Lead – per volume (µg/L)All Ages0.0-5.0 µg/L
Creatinine, random, per volumeAll AgesNot established mg/dL
Creatinine, per 24 hoursFemale, 3-8 years140-700 mg/d
Female, 9-12 years300-1300 mg/d
Female, 13-17 years400-1600 mg/d
Female, 18-50 years700-1600 mg/d
Female, 51-80 years500-1400 mg/d
Female, ≥81 years400-1300 mg/d
Male, 3-8 years140-700 mg/d
Male, 9-12 years300-1300 mg/d
Male, 13-17 years500-2300 md/d
Male, 18-50 years1000-2500 mg/d
Male, 51-80 years800-2100 mg/d
Male, ≥81 years600-2000 mg/d

Clinical Significance: Useful in the assessment of acute and chronic exposure to arsenic, mercury, and lead. Quantification of urine excretion rates before or after chelation therapy has been used as an indicator of lead exposure. Urinary excretion of >125 mg of lead per 24 hours is usually associated with related evidence of lead toxicity. Urinary mercury levels of predominantly reflect acute or chronic elemental or inorganic mercury exposure. Urine concentrations in unexposed individuals are typically less than 10 µg/L. Twenty-four-hour urine concentrations of 30 to 100 µg/L may be associated with subclinical neuropsychiatric symptoms and tremor while concentrations greater than 100 µg/L can be associated with overt neuropsychiatric disturbances and tremors. Urine mercury levels may be useful in monitoring chelation therapy.

The ACGIH Biological Exposure Index (BEI) for the sum of inorganic and methylated forms (species) of arsenic is 35 ug/L. For specimens with total arsenic concentrations between 25-2000 ug/L, fraction is performed to determine the proportion of the inorganic, methylated, and organic forms. Inorganic forms of arsenic are most toxic. Methylated forms arise primarily from metabolism of inorganic forms but may also come from dietary sources and are of moderate toxic potential. The organic forms of arsenic are considered nontoxic and arise primarily from food. The sum of the inorganic, methylated, and organic forms of arsenic may be lower than the total arsenic level. It may be appropriate to request fractionation for specimens with a 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.

The CPT codes provided are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.