Test Catalog

Test Id : SPAS

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Arsenic Speciation, Random, Urine

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Overview

Test Catalog

Useful For
Suggests clinical disorders or settings where the test may be helpful

Diagnosis of arsenic intoxication using random urine specimens

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

Total arsenic will be performed first. If the total arsenic concentration is 10 mcg/L or greater, then speciation will be performed and reported. If total arsenic is below 10 mcg/L, total arsenic will be reported as less than 10 mcg/L and speciation will not be performed.

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Method Name
A short description of the method used to perform the test

Total Arsenic Result: Triple-Quadrupole Inductively Coupled Plasma-Mass Spectrometry (ICP-MS/MS)

Speciation Results: Ion Chromatography Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Arsenic Speciation, Random, U

Aliases
Lists additional common names for a test, as an aid in searching

Arsenic (As)

Arsenic, Inorganic Forms

Arsenic, Organic Forms

As (Arsenic)

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

Total arsenic will be performed first. If the total arsenic concentration is 10 mcg/L or greater, then speciation will be performed and reported. If total arsenic is below 10 mcg/L, total arsenic will be reported as less than 10 mcg/L and speciation will not be performed.

Specimen Type
Describes the specimen type validated for testing

Urine

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Patient Preparation:

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 metal tests. If either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for at least 96 hours.

Supplies:

-Urine Tubes, 10 mL (T068)

-Sarstedt 5 mL Aliquot Tube (T914)

Collection Container/Tube: Clean, plastic urine collection container

Submission Container/Tube: Plastic vial or a clean, plastic aliquot container with no metal cap or glued insert

Specimen Volume: 5 mL

Collection Instructions:

1. Collect a random urine specimen.

2. See Trace Metals Analysis Specimen Collection and Transport for complete instructions.

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

3 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

  All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Urine Refrigerated (preferred) 28 days
Frozen 28 days
Ambient 72 hours

Useful For
Suggests clinical disorders or settings where the test may be helpful

Diagnosis of arsenic intoxication using random urine specimens

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

Total arsenic will be performed first. If the total arsenic concentration is 10 mcg/L or greater, then speciation will be performed and reported. If total arsenic is below 10 mcg/L, total arsenic will be reported as less than 10 mcg/L and speciation will not be performed.

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Arsenic (As) exists in a number of different forms; some are toxic, while others are not. The toxic inorganic forms are arsenite (As[3+], As[III]) and arsenate (As[5+], As[V]), and their partially detoxified metabolites are monomethylarsine (MMA) and dimethylarsine (DMA). As(III) is more toxic than As(V) and both are more toxic than MMA and DMA.  AsIII is more toxic than AsV, and both are more toxic than mono- and dimethylarsine. The biologic half-life of inorganic arsenic is 4 to 6 hours, while the biologic half-life of the methylated metabolites is 20 to 30 hours. Target organs of As-III-induced effects are the heart, gastrointestinal tract, skin and other epithelial tissues, kidney, and nervous system.

 

Inorganic arsenic is carcinogenic to humans. Symptoms of chronic poisoning, called arseniasis, are mostly insidious and nonspecific. The gastrointestinal tract, skin, and central nervous system are usually involved. Nausea, epigastric pain, colic abdominal pain, diarrhea, and paresthesias of the hands and feet can occur.

 

Nontoxic, organic forms of arsenic are present in many foods. Arsenobetaine and arsenocholine are the 2 most common forms of organic arsenic found in food. The most common foods that contain significant concentrations of organic arsenic are shellfish and other predators in the seafood chain (cod, haddock, etc). Some meats, such as meats from chickens that have been fed on seafood remnants, may also contain the organic forms of arsenic.

 

Following ingestion of arsenobetaine and arsenocholine, these compounds undergo rapid renal clearance to become concentrated in the urine. Organic arsenic is completely excreted within 1 to 2 days after ingestion and there are no residual toxic metabolites. The biologic half-life of organic arsenic is 4 to 6 hours.

 

For reporting purposes, the concentrations of the inorganic forms (As[III] and As[V]) along with the methylated forms (MMA and DMA) will be summed and reported together as 'Inorganic' arsenic. This is consistent with how the biological exposure index (BEI) reference range is reported.

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.

TOXIC ARSENIC

<35 mcg/L

Reference values apply to all ages.

 

Arsenic Speciation Interpretive Information:

The toxic arsenic concentration represents the sum of the inorganic and methylated arsenic species. The reference value for toxic arsenic is <35 mcg/L. This value is based on the ACGIH Biological Exposure Index (BEI), which does not include the nontoxic organic arsenic.

Interpretation
Provides information to assist in interpretation of the test results

The quantitative reference range for fractionated arsenic applies only to the inorganic forms. Concentrations of 20 mcg inorganic arsenic per liter or higher are considered toxic.

 

There is no limit to the normal range for the organic forms of arsenic since they are not considered to be toxic and are normally present after consumption of certain food types. For example, a typical finding in a urine specimen with total 24-hour excretion of arsenic of 350 mcg/24 hr would be that more than 95% is present as the organic species from a dietary source, and less than 5% is present as the inorganic species. This would be interpreted as indicating the elevated total arsenic was due to ingestion of the nontoxic form of arsenic, usually found in seafood.

 

A normal value for blood arsenic does not exclude a finding of elevated urine inorganic arsenic, due to the very short half-life of blood arsenic.

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Consumption of seafood before collection of a urine specimen for arsenic testing is likely to result in a report of an elevated concentration of organic arsenic, which can be clinically misleading.

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Caldwell KL, Jones RL, Verdon CP, Jarrett JM, Caudill SP, Osterloh JD: Levels of urinary total and speciated arsenic in the US population: National Health and Nutrition Examination Survey 2003-2004. J Expo Sci Environ Epidemiol. 2009 Jan;19(1):59-68. doi: 10.1038/jes.2008.32

2. Agency for Toxic Substances and Disease Registry: Toxicological profile for arsenic. US Department of Health and Human Services; 2007. Available at www.atsdr.cdc.gov/ToxProfiles/tp2.pdf

3. Strathmann FG, Blum LM: Toxic elements. In: Rifai N, Horwath AR, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018:chap 42

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Method Description
Describes how the test is performed and provides a method-specific reference

Inorganic (AsIII, AsV), organic (arsenobetaine, arsenocholine), and methylated (monomethylarsonic acid, dimethylarsinic acid) arsenic species in urine are separated using ion chromatography and quantitated by inductively coupled plasma-mass spectrometry in kinetic energy discrimination sensitive mode using an internal standard and a mobile phase matrix calibration.(Wegwerth PJ, Erdahl SA, Wermers ML, Hanley MM, Eckdahl SJ, Jannetto PJ: Reliable, rapid, and robust speciation of arsenic in urine by IC-ICP-MS. J Appl Lab Med. 2021 Jul 7;6(4):846-857. doi: 10.1093/jalm/jfaa226)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Friday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

3 to 5 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

14 days

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their Regional Manager. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

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 Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

82175

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
SPAS Arsenic Speciation, Random, U 54454-4
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
607692 Inorganic Arsenic (Toxic) 12481-8
607693 Methylated Arsenic (Toxic) 53779-5
607694 Organic Arsenic (Non-Toxic) 53778-7
609405 Toxic Arsenic Concentration 96250-6
607691 Total Arsenic Concentration 5586-3

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports