Arsenic

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Report in 12Hrs

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No Fasting Required

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Heavy metal assay for arsenic.

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Arsenic Test - Comprehensive Medical Information Guide

Why is it done?
- Test Purpose: Measures the level of arsenic in the blood, urine, or hair to detect acute or chronic arsenic exposure and toxicity
- Acute Exposure Evaluation: Performed when arsenic poisoning is suspected following recent exposure (hours to days), typically involving sudden onset of gastrointestinal symptoms, cardiac arrhythmias, or neurological changes
- Chronic Exposure Assessment: Ordered to identify long-term arsenic exposure from occupational hazards (mining, pesticide use, smelting), contaminated water sources, or environmental pollution
- Occupational Monitoring: Performed regularly for workers in industries with potential arsenic exposure to maintain workplace safety standards and detect early toxic accumulation
- Forensic Investigation: Used in cases of suspected poisoning or criminal toxicology investigations
- Environmental Exposure Screening: Performed for populations living in areas with arsenic-contaminated groundwater or soil
- Symptom Investigation: Ordered when patients present with unexplained peripheral neuropathy, skin changes (hyperpigmentation, keratosis), gastrointestinal disturbances, or malignancy risk assessment
Normal Range
- Blood Arsenic: Less than 23 µg/L (micrograms per liter) or 0.3 µmol/L (micromoles per liter)
- Urine Arsenic: Less than 50-60 µg/L, with some labs using 35 µg/L as cutoff (preferred specimen for chronic exposure)
- Hair Arsenic: Less than 1 mg/kg (milligrams per kilogram) of hair
- Reference Ranges Variation: Normal ranges may vary by laboratory, geographic location (higher in endemic areas), and testing methodology (ICP-MS, AAS). Values above the upper limit suggest exposure or accumulation.
- Mild Elevation (23-50 µg/L blood): May indicate mild chronic exposure or occupational contact; requires clinical correlation
- Moderate Elevation (50-100 µg/L blood): Suggests significant exposure with potential for health effects; warrants investigation and intervention
- Severe Elevation (>100 µg/L blood): Indicates acute or significant chronic arsenic toxicity; medical emergency requiring immediate intervention
Interpretation
- Normal Results (<23 µg/L blood or <50 µg/L urine): Indicates arsenic levels within typical background exposure ranges; no acute or significant chronic toxicity detected; environmental and occupational exposure appears minimal
- Elevated Results: Suggests exposure to arsenic from unknown or known sources; degree of elevation correlates with exposure severity and duration; must differentiate between organic arsenic (food-related, less toxic) and inorganic arsenic (environmental, more toxic)
- Acute Poisoning Pattern: Blood levels peak within hours of ingestion and decline over days; highest levels typically seen in acute cases; accompanied by severe gastrointestinal symptoms, hypotension, and cardiac dysrhythmias
- Chronic Exposure Pattern: Urine levels provide better indicator than blood; hair testing shows historical exposure over months; progressive accumulation in tissues with development of peripheral neuropathy, skin manifestations, and carcinogenic effects
- Specimen Type Considerations: Blood arsenic best for acute exposure; urine arsenic best for recent chronic exposure (past 2-3 weeks); hair arsenic best for historical exposure (past months); speciation testing (organic vs. inorganic) provides toxicological differentiation
- Modifying Factors: Dietary intake of seafood (contains organic arsenic); occupational exposure history; geographic location and water source; metabolic rate affecting arsenic clearance; renal and hepatic function; concurrent mineral deficiencies affecting absorption
- Clinical Correlation Required: Results must be interpreted alongside clinical symptoms, exposure history, and physical examination findings; presence of arsenic does not automatically confirm toxicity; multiple biomarkers and repeat testing often necessary for diagnosis
Associated Organs
- Primary Organ Systems Affected:
- Gastrointestinal System: Most severely affected in acute poisoning; causes hemorrhagic gastroenteritis, severe abdominal pain, vomiting, watery diarrhea, malabsorption; chronic exposure linked to increased gastrointestinal malignancy risk
- Cardiovascular System: Acute toxicity causes myocarditis, arrhythmias (QT prolongation), hypotension, and cardiogenic shock; chronic exposure increases hypertension, atherosclerosis, and coronary artery disease risk
- Nervous System: Peripheral neuropathy is classic chronic manifestation (sensorimotor, predominantly sensory); encephalopathy in severe cases; developmental neurotoxicity in children affecting cognition and motor function
- Integumentary System (Skin): Hyperpigmentation, particularly in flexural areas and trunk; hyperkeratosis of palms and soles; Bowen's disease (intraepidermal carcinoma); increased squamous cell and basal cell carcinoma risk
- Renal System: Acute tubular necrosis in severe poisoning; chronic exposure associated with chronic kidney disease, glomerulonephritis, and proteinuria; compromised renal clearance prolongs arsenic retention
- Hepatic System: Hepatotoxicity with elevated liver enzymes; fatty infiltration, cirrhosis in chronic exposure; increased hepatocellular carcinoma risk
- Hematologic System: Anemia, leukopenia, thrombocytopenia; bone marrow suppression in chronic exposure; increased leukemia risk
- Associated Diseases and Conditions:
- Acute Arsenic Poisoning: Medical emergency with multi-organ involvement and high mortality if untreated
- Chronic Arsenic Exposure Syndrome: Progressive systemic effects with neurological and dermatological predominance
- Arsenical Neuropathy: Distal, symmetrical, sensorimotor peripheral neuropathy; potential for chronic pain and disability
- Lung Cancer: Increased risk with inhalation exposure in occupational settings
- Bladder and Kidney Cancers: Associated with drinking water contamination
- Skin Cancers (Bowen's Disease): Non-melanoma cutaneous malignancy commonly associated with chronic arsenicosis
- Diabetes Mellitus: Chronic arsenic exposure increases glucose intolerance and diabetes risk
- Immunosuppression: Chronic exposure impairs immune function and increases infection susceptibility
Follow-up Tests
- Immediate Follow-up for Acute Exposure:
- Electrolyte Panel: Monitor sodium, potassium, magnesium, calcium for severe gastrointestinal losses and cardiac effects
- Renal Function Tests: Assess serum creatinine, blood urea nitrogen (BUN), and urinalysis for acute tubular necrosis
- Hepatic Function Tests: Evaluate aspartate aminotransferase (AST), alanine aminotransferase (ALT), bilirubin for hepatocellular damage
- ECG Monitoring: Screen for arrhythmias, QT prolongation, and cardiac conduction abnormalities
- Complete Blood Count (CBC): Identify anemia, thrombocytopenia, or leukopenia indicating bone marrow involvement
- Arsenic Speciation: Differentiate organic from inorganic arsenic forms for toxicological assessment
- Diagnostic Investigations for Chronic Exposure:
- Electromyography (EMG) and Nerve Conduction Studies (NCS): Confirm and characterize peripheral neuropathy; assess demyelination vs. axonal damage
- Skin Biopsy: If suspicious skin lesions present; rule out Bowen's disease and malignancy
- Dermatological Examination: Screen for characteristic hyperpigmentation, hyperkeratosis, and cutaneous malignancies
- Chest X-ray: Evaluate for malignancy or other pulmonary manifestations in occupational exposure
- Fasting Glucose and HbA1c: Screen for diabetes mellitus and glucose intolerance associated with chronic exposure
- Cancer Screening Recommendations:
- Urinalysis and Urine Cytology: Screen for bladder and kidney cancers in high-exposure populations
- Chest CT Scan: In occupational exposure settings for lung cancer surveillance
- Liver Ultrasound or CT: Assess for cirrhosis and hepatocellular carcinoma in chronic exposure
- Long-term Monitoring Protocol:
- Repeat Urine Arsenic Testing: Every 6-12 months for occupational exposure monitoring or if exposure continues
- Periodic Follow-up Arsenic Level: After therapeutic intervention to confirm clearance and assess treatment efficacy
- Annual Comprehensive Metabolic Panel: Monitor long-term organ damage in chronic exposure cases
- Regular Dermatological Surveillance: Annual skin examination for suspicious lesions and malignancy
Fasting Required?
- Fasting Status: NO
- Fasting is not required for arsenic testing. Food and fluid intake do not significantly affect blood, urine, or hair arsenic measurements.
- General Preparation Instructions:
- Standard Precautions: Follow routine phlebotomy protocols; no special equipment needed beyond standard collection tubes
- Medications: No medications need to be discontinued specifically for this test; however, inform healthcare provider of all current medications
- Supplements: Chelation agents or mineral supplements should be noted; high-dose selenium or other antioxidant supplements may be discussed with provider
- Specimen Collection Specifics:
- Blood Collection: Can be collected at any time of day; collected in metal-free tube to prevent contamination; no timing restrictions relative to meals
- Urine Collection: 24-hour urine collection preferred for chronic exposure assessment; first morning void acceptable for screening; normal food intake appropriate
- Hair Collection: Hair sample (5-10 strands) should be cut close to scalp from vertex area; no special preparation needed; natural hair preferred (avoid dyed or treated hair if possible)
- Important Patient Information:
- Inform Healthcare Provider: If exposure is suspected or known; if patient works in high-risk occupation; if there are symptoms of poisoning
- Avoid Contamination: Ensure hands and collection site are clean to prevent external contamination of specimen
- Documentation: Note exact time of collection, especially for urine specimens; provide occupational/exposure history to laboratory
- Treatment Considerations: If chelation therapy is considered (for high levels), it should be initiated by toxicology or occupational medicine specialists; treatment typically uses agents like dimercaprol (BAL) or succimer (DMSA)

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