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Test Code MNCRU Manganese/Creatinine Ratio, Random, Urine

Reporting Name

Manganese/Creat Ratio, Random, U

Useful For

Monitoring manganese exposure

 

Nutritional monitoring

 

Clinical trials

Profile Information

Test ID Reporting Name Available Separately Always Performed
MNCR Manganese/Creat Ratio, U No Yes
CDCR Creatinine Conc No Yes

Method Name

MNCR: Dynamic Reaction Cell-Inductively Coupled Plasma-Mass Spectrometry (DRC-ICP-MS)

CDCR: Enzymatic Colorimetric Assay

Performing Laboratory

Mayo Medical Laboratories in Rochester

Specimen Type

Urine


Specimen Required


Collection Container/Tube: Clean, plastic urine collection container

Submission Container/Tube: Plastic, 10-mL urine tube (T068) or clean, plastic aliquot container with no metal cap or glued insert

Specimen Volume: 3 mL

Collection Instructions:

1. Collect a random urine specimen.

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

Additional Information: 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

0.8 mL

Specimen Stability Information

Specimen Type Temperature Time
Urine Refrigerated (preferred) 28 days
  Frozen  28 days
  Ambient  7 days

Reject Due To

Hemolysis

NA

Lipemia

NA

Icterus

NA

Other

NA

Reference Values

<4.0 mcg/g creatinine

Reference values have not been established for patients that are <18 years of age.

Day(s) and Time(s) Performed

Tuesday, Friday; 8 a.m.

CPT Code Information

83785 Manganese Concentration

82570 Creatinine Concentration

LOINC Code Information

Test ID Test Order Name Order LOINC Value
MNCRU Manganese/Creat Ratio, Random, U In Process

 

Result ID Test Result Name Result LOINC Value
CDCR Creatinine Conc 2161-8
32867 Manganese/Creat Ratio, U 27367-2

Specimen Retention Time

14 days

Method Description

This assay is performed on an inductively coupled plasma-mass spectrometer in dynamic reaction cell mode. Calibrating standards and blanks are diluted with an aqueous acidic diluent containing internal standards. Quality control specimens and patient samples are diluted in an identical manner. In turn, all diluted blanks, calibrating standards, quality control specimens, and patient specimens are aspirated into a pneumatic nebulizer and the resulting aerosol directed to the hot plasma discharge by a flow of argon. In the annular plasma the aerosol is vaporized, atomized, and then ionized. The ionized gases, plus neutral species formed in the annular plasma space, are aspirated from the plasma through an orifice into a quadrupole mass spectrometer. The mass range from 1 to 263 amu is rapidly scanned multiple times and ion counts tabulated for each mass of interest. Instrument response is defined by the linear relationship of analyte concentration vs. ion count ratio (analyte ion count/internal standard ion count). Analyte concentrations are derived by reading the ion count ratio for each mass of interest and determining the concentration from the response line.(Unpublished Mayo method)

 

Creatinine is measured using an enzymatic method based on the determination of sarcosine from creatinine with the aid of creatininase, creatinase, and sarcosine oxidase. The liberated hydrogen peroxide is measured via a modified Trinder reaction using a colorimetric indicator.(Package insert: Roche Diagnostics, Indianapolis IN, 2004)

Analytic Time

1 day

Cautions

Specimens collected from healthy, unexposed adults have extremely low levels of manganese. Because of the high environmental concentration of manganese, contamination is always a possibility when considering elevated results. Precautions must be taken to ensure the specimen is not contaminated. Metal-free urine collection procedures must be followed.

 

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.

Clinical Information

Manganese (Mn) is an essential trace element with many industrial uses. Manganese is the 12th most abundant element in the earth's crust and is used predominantly in the production of steel. These industrial processes cause elevated environmental exposures to airborne manganese dust and fumes, which in turn have led to well-documented cases of neurotoxicity among exposed workers. Mining and iron and steel production have been implicated as sources of exposure.

 

Inhalation is the primary source of entry for manganese toxicity. Signs of toxicity may appear quickly or not at all; neurological symptoms are rarely reversible. Manganese toxicity is generally recognized to progress through 3 stages. Levy describes these stages. "The first stage is a prodrome of malaise, somnolence, apathy, emotional lability, sexual dysfunction, weakness, lethargy, anorexia, and headaches. If there is continued exposure, progression to a second stage may occur, with psychological disturbances, including impaired memory and judgment, anxiety, and sometimes psychotic manifestations such as hallucinations. The third stage consists of progressive bradykinesia, dysarthrian axial and extremity dystonia, paresis, gait disturbances, cogwheel rigidity, intention tremor, impaired coordination, and a mask-like face. Many of those affected may be permanently and completely disabled."(1)

 

Few cases of manganese deficiency or toxicity due to ingestion have been documented. Only 1% to 3% manganese is absorbed via ingestion, while most of the remaining manganese is excreted in the feces. As listed in the United States National Agriculture Library, manganese adequate intake is 1.6 to 2.3 mg/day for adults. This level of intake is easily achieved without supplementation by a diverse diet including fruits and vegetables, which have higher amounts of manganese than other food types. Patients on a long-term parenteral nutrition should receive manganese supplementation and should be monitored to ensure that circulatory levels of manganese are appropriate.

Interpretation

Manganese in urine represents the excretion of excess manganese from the body, and may be used to monitor exposure or excessive nutritional intake.

Test Classification

See Individual Test IDs