Test ID: HMSUO
Heavy Metals Screen Occupational Exposure, Urine
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Screening potentially exposed workers for heavy metal toxicity in settings where a 24-hour collection is problematic
Profile Information A profile is a group of laboratory tests that are ordered and performed together under a single Mayo Test ID. Profile information lists the test performed, inclusive of the test fee, when a profile is ordered and includes reporting names and individual availability.
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| CDCR | Creatinine Conc | No | Yes |
| ARCO | As Conc | No | Yes |
| PBCO | Pb Conc | No | Yes |
| CDUOM | Cd Conc | Yes, (order CDU) | Yes |
| HGCO | Hg Conc | Yes, (order HGOM) | Yes |
Special Instructions and Forms Describes specimen collection and preparation information, test algorithms, and other information pertinent to test. Also includes pertinent information and consent forms to be used when requesting a particular test
Method Name A short description of the method used to perform the test
CDCR;7243: Enzymatic Colorimetric Assay
ARCO/21669, PBCO/21672, CDUOM/7244, HCGO/21666: Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
As (Arsenic)
Cadmium (Cd)
Cd (Cadmium)
Hg (Mercury)
Lead (Pb)
Mercury (Hg)
Metals Screen
Pb (Lead)
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Collection Container/Tube: Clean, plastic urine collection container
Submission Container/Tube: Plastic, 6-mL tube (Supply T465) or a clean, plastic aliquot container with no metal cap or glued insert
Specimen Volume: 6 mL
Collection Instructions:
1. Collect a random urine specimen.
2. Shake specimen gently.
3. See Metals Analysis-Collection and Transport in Special Instructions for complete instructions.
Additional Information:
1. Patient should not eat seafood for a 48-hour period prior to start of collection.
2. High concentrations of gadolinium and iodine are known to interfere with most metals tests. If either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for 96 hours.
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | NA |
| Lipemia | NA |
| Icterus | NA |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Urine | Refrigerated (preferred) | 7 days |
| Frozen | 7 days |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Arsenic (As), lead (Pb), cadmium (Cd), and mercury (Hg) are well-known toxins and toxic exposures are characterized by increased urinary excretion of these metals.
Arsenic exists in a number of different forms; some are toxic while others are not. Toxic forms, which are typically encountered as a result of an industrial exposure, are the inorganic species As (+3) (As-III) and As (+5) (As-V) and the partially detoxified metabolites, monomethylarsine and dimethylarsine. The 2 most common nontoxic forms are arsenobetaine and arsenocholine. Arsenic toxicity affects a number of organ systems.
Lead toxicity primarily affects the gastrointestinal, neurologic, and hematopoietic systems.
Chronic exposure to cadmium causes accumulated renal damage.
Mercury is essentially nontoxic in its elemental form. However, once it is chemically modified to the ionized, inorganic species, Hg(++), it becomes toxic. Further bioconversion to an alkyl mercury, such as methyl Hg (CH[3]Hg[+]), yields a species of mercury that is highly selective for lipid-rich tissue, such as the myelin sheath, and is very toxic.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
ARSENIC/CREATININE
<50 mcg/g
MERCURY/CREATININE
<35 mcg/g
CADMIUM/CREATININE
<3.0 mcg/g
LEAD/CREATININE
<5 mcg/g
Interpretation Provides information to assist in interpretation of the test results
The reference intervals for this test are Occupational Safety and Health Adminstration (OSHA) thresholds.
The ordering physician will be contacted regarding any result exceeding OSHA thresholds to determine the level of workplace exposure and follow-up action.
Arsenic results exceeding the OSHA threshold will be fractionated to confirm the presence of toxic forms.
Measurement of urine excretion rates either before or after chelation therapy has been used as an indicator of lead exposure. However, blood lead analysis has the strongest correlation with toxicity.
Normally, the excretion of cadmium is proportional to creatinine. When renal damage has occurred, cadmium excretion increases relative to creatinine.
The correlation between the levels of mercury in the urine and clinical symptoms is poor, but urinary mercury is the most reliable way to assess exposure to inorganic mercury.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Nitric acid cannot be added to either the collection or aliquot container. Nitrate interferes with the extraction procedure that would need to take place in the event of a positive arsenic result.
High concentrations of gadolinium and iodine are known to interfere with most metals tests. If either gadolinium- or iodine-containing contrast media has been administered, a specimen cannot be collected for 96 hours.
This test is intended for use as a screening tool for occupational monitoring. It is not a replacement of HMSU/8633 Heavy Metals Screen, 24 Hour, Urine.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
See individual test descriptions for:
-ASCRU/89890 Arsenic/Creatinine Ratio, Random, Urine
-PBCRU/60247 Lead/Creatinine Ratio, Random, Urine
-CDOM/80595 Cadmium Occupational Monitor, Urine
-HGOM/82755 Mercury Occupational Monitor, Urine
Method Description Describes how the test is performed and provides a method-specific reference
See individual test descriptions for:
-ASCRU/89890 Arsenic/Creatinine Ratio, Random, Urine
-PBCRU/60247 Lead/Creatinine Ratio, Random, Urine
-CDOM/80595 Cadmium Occupational Monitor, Urine
-HGOM/82755 Mercury Occupational Monitor, Urine
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday through Friday; 3 p.m. - 9 p.m.; Saturday; 8 a.m. – 3 p.m./Continuously
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
82175-Arsenic
82300-Cadmium
83655-Lead
83825-Mercury
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| CDCR | Creatinine Conc | 35674-1 |
| 21670 | As Conc | 5586-3 |
| 860 | Cd Conc | 5611-9 |
| 21667 | Hg Conc | 5689-5 |
| 21673 | Pb Conc | 5676-2 |
| 21674 | Pb/Creatinine Ratio | 13466-8 |
| 21679 | Hg/Creatinine Ratio | 13465-0 |
| 7242 | Cd/Creatinine Ratio | 13471-8 |
| 21671 | As/Creatinine Ratio | 13463-5 |
| 21668 | Inorganic As/Cr Ratio | 13825-5 |
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