Skip Ribbon Commands
Skip to main content
Sign In
Navigate Up

26102 Heavy Metal Occupational Exposure, with Reflex, Urine (HMSOR)

Heavy Metal Occupational Exposure, with Reflex, Urine (HMSOR)
Test Code: HMSORSO
Synonyms/Keywords
Arsenic (As), As (Arsenic), Cadmium (Cd), Cd (Cadmium), Mercury (Hg), Hg (Mercury), Lead (Pb), Pb (Lead)
Test Components
Arsenic, Cadmium, Mercury, Lead
Useful For

Preferred screening test for detection of arsenic, cadmium, mercury and lead due to occupational exposure in random urine specimens. 

If arsenic concentration is greater than or equal to 35 mcg/L, then fractionation will be performed at an additional charge.

Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​No ​Urine ​Clean, plastic urine container with no metal cap or glued insert ​ ​6 mL ​3 mL ​
Collection Processing Instructions

1. Collect a random urine specimen.

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

Patient Preparation:
-Patient should not eat seafood for a 48-hour period prior to start of collection.
-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 Stability Information
Specimen Type Temperature Time
​Urine ​ ​Refrigerate (preferred) ​7 days
​Frozen ​7 days
Interference

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

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.

Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Mayo Medical Laboratories ​Monday through Friday ​1 day

​ARSO, CDOE, HGOE, PBOE: Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)

CDCR: Enzymatic Colorimetric Assay

Reference Lab
Mayo Clinic Laboratories
Reference Range Information
Performing Location Reference Range
​Marshfield ​ARSENIC:
Biological Exposure Indices (BEI): <35 mcg/L at end of work week
 
CADMIUM:
Biological Exposure Indices (BEI): <5.0 mcg/g creatinine
 
MERCURY:
Biological Exposure Index (BEI): <35 mcg/g creatinine
 
LEAD:
Biological Exposure Index (BEI): <150 mcg/g creatinine
Interpretation
​Arsenic:
Normally, humans consume 5 to 25 mcg of arsenic each day as part of their normal diet; therefore, normal urine arsenic output is below 35 mcg arsenic per gram creatinine (<35 mcg/g). When exposed to inorganic arsenic, the urine output may be more than 1,000 mcg/g and remain elevated for weeks. After a seafood meal (seafood contains a nontoxic, organic form of arsenic), on the other hand, the urine output of arsenic may be above 200 mcg/g, after which it will decline to below 35 mcg/g over a period of 1 to 2 days.

Exposure to inorganic arsenic, the toxic form of arsenic, causes prolonged excretion of arsenic in the urine for many days. Urine excretion rates above 1,000 mcg/g indicates significant exposure. The highest value observed at Mayo Clinic was 450,000 mcg/L in a patient with severe symptoms of gastrointestinal distress, shallow breathing with classic "garlic breath," intermittent seizure activity, cardiac arrhythmias, and later onset of peripheral neuropathy.
 
Cadmium:
Cadmium excretion greater than 3.0 mcg/g creatinine indicates significant exposure to cadmium.  Results greater than 15 mcg/g creatinine are considered indicative of severe exposure.
Mercury:
Urinary mercury (Hg) is the most reliable way to assess exposure to inorganic Hg, but the correlation between the levels of excretion in the urine and clinical symptoms is poor.
 
Lead:
Urinary excretion of less than 4 mcg/g creatinine is not associated with any significant lead exposure.
Urinary excretion of more than 4 mcg/g creatinine is usually associated with pallor, anemia, and other evidence of lead toxicity.
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​82175 ​ ​1 ​ ​
​82300 ​ ​1 ​ ​
​83825 ​ ​1 ​ ​
​83655 ​ ​1 ​ ​
​82570 ​ ​1 ​ ​
Synonyms/Keywords
Arsenic (As), As (Arsenic), Cadmium (Cd), Cd (Cadmium), Mercury (Hg), Hg (Mercury), Lead (Pb), Pb (Lead)
Test Components
Arsenic, Cadmium, Mercury, Lead
Ordering Applications
Ordering Application Description
​Cerner ​Heavy Metals Occ Exp (HMSOR)
​Centricity ​Heavy Metals Occ Exp (HMSOR)
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​No ​Urine ​Clean, plastic urine container with no metal cap or glued insert ​ ​6 mL ​3 mL ​
Collection Processing

1. Collect a random urine specimen.

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

Patient Preparation:
-Patient should not eat seafood for a 48-hour period prior to start of collection.
-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 Stability Information
Specimen Type Temperature Time
​Urine ​ ​Refrigerate (preferred) ​7 days
​Frozen ​7 days
Interference

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

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.

Useful For

Preferred screening test for detection of arsenic, cadmium, mercury and lead due to occupational exposure in random urine specimens. 

If arsenic concentration is greater than or equal to 35 mcg/L, then fractionation will be performed at an additional charge.

Test Components
Arsenic, Cadmium, Mercury, Lead
Reference Range Information
Performing Location Reference Range
​Marshfield ​ARSENIC:
Biological Exposure Indices (BEI): <35 mcg/L at end of work week
 
CADMIUM:
Biological Exposure Indices (BEI): <5.0 mcg/g creatinine
 
MERCURY:
Biological Exposure Index (BEI): <35 mcg/g creatinine
 
LEAD:
Biological Exposure Index (BEI): <150 mcg/g creatinine
Interpretation
​Arsenic:
Normally, humans consume 5 to 25 mcg of arsenic each day as part of their normal diet; therefore, normal urine arsenic output is below 35 mcg arsenic per gram creatinine (<35 mcg/g). When exposed to inorganic arsenic, the urine output may be more than 1,000 mcg/g and remain elevated for weeks. After a seafood meal (seafood contains a nontoxic, organic form of arsenic), on the other hand, the urine output of arsenic may be above 200 mcg/g, after which it will decline to below 35 mcg/g over a period of 1 to 2 days.

Exposure to inorganic arsenic, the toxic form of arsenic, causes prolonged excretion of arsenic in the urine for many days. Urine excretion rates above 1,000 mcg/g indicates significant exposure. The highest value observed at Mayo Clinic was 450,000 mcg/L in a patient with severe symptoms of gastrointestinal distress, shallow breathing with classic "garlic breath," intermittent seizure activity, cardiac arrhythmias, and later onset of peripheral neuropathy.
 
Cadmium:
Cadmium excretion greater than 3.0 mcg/g creatinine indicates significant exposure to cadmium.  Results greater than 15 mcg/g creatinine are considered indicative of severe exposure.
Mercury:
Urinary mercury (Hg) is the most reliable way to assess exposure to inorganic Hg, but the correlation between the levels of excretion in the urine and clinical symptoms is poor.
 
Lead:
Urinary excretion of less than 4 mcg/g creatinine is not associated with any significant lead exposure.
Urinary excretion of more than 4 mcg/g creatinine is usually associated with pallor, anemia, and other evidence of lead toxicity.
For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Mayo Medical Laboratories ​Monday through Friday ​1 day

​ARSO, CDOE, HGOE, PBOE: Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)

CDCR: Enzymatic Colorimetric Assay

Reference Lab
Mayo Clinic Laboratories
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​82175 ​ ​1 ​ ​
​82300 ​ ​1 ​ ​
​83825 ​ ​1 ​ ​
​83655 ​ ​1 ​ ​
​82570 ​ ​1 ​ ​
For most current information refer to the Marshfield Laboratory online reference manual.