Interpretation

Physiologically, arsenic exists in toxic and nontoxic forms. The total arsenic concentration reflects all arsenic present in the sample regardless of species (eg, inorganic vs. methylated vs. organic arsenic). The measurement of urinary total arsenic levels is generally accepted as the most reliable indicator of recent arsenic exposure. However, if the total urine arsenic concentration is elevated, arsenic speciation must be performed to identify if it is a toxic form (eg, inorganic and methylated forms) or a relatively nontoxic organic form (eg, arsenobetaine and arsenocholine).

The inorganic toxic forms of arsenic (eg, As[III] and As[V]) are found in the urine shortly after ingestion, whereas the less toxic methylated forms (monomethylarsonic acid [MMA], dimethylarsinic acid [DMA]) are the species that predominate longer than 24 hours after ingestion. In general, urinary As(III) and As(V) concentrations peak in the urine at approximately 10 hours and return to normal 20 to 30 hours after ingestion. Urinary MMA and DMA concentrations normally peak at approximately 40 to 60 hours and return to baseline 6 to 20 days after ingestion.

After a seafood meal (seafood generally contains the nontoxic, organic form of arsenic (eg, arsenobetaine), the urine output of arsenic may increase to over 300 mcg/24 h, after which it will decline.

This test can determine if the patient has been exposed to above-average levels of arsenic. It cannot predict whether the arsenic levels in their body will affect their health.