Some standard content:
ICs13.100
National Occupational Health Standard of the People's Republic of China GBZ17—2002
Diagnostic Criteria of Occupational Cadmium Poisoning2002-04-08 Issued
Ministry of Health of the People's Republic of China
Implementation on 2002-06-01
Article 6.1 of this standard is recommended, and the rest are mandatory. This standard is formulated in accordance with the "Law of the People's Republic of China on the Prevention and Control of Occupational Diseases". From the date of implementation of this standard, if the original standard GB7803-1987 is inconsistent with this standard, this standard shall prevail. Acute and chronic poisoning may occur in occupational activities involving contact with cadmium and its compounds. In order to protect the health of the contactors and effectively prevent and control cadmium poisoning, GB7803-1987 was issued. The revised standard divides acute cadmium poisoning into three levels: mild, moderate and severe, to guide clinical emergency work; the diagnostic values of urinary cadmium and urinary 2-microglobulin for chronic cadmium poisoning are changed to be expressed in a unit corrected by creatinine, and the urine protein electrophoresis examination index, which is currently not commonly used, is deleted, and the urine retinol binding protein determination index is added, making the diagnosis of chronic mild cadmium poisoning more reasonable and easier to grasp. When workers who have been exposed to cadmium compounds for a long time have abnormally increased urine β2-microglobulin and (or) retinol binding protein, after excluding other causes, they can be diagnosed as mild cadmium poisoning; when chronic renal insufficiency occurs, which may be accompanied by osteoporosis and osteomalacia, it is diagnosed as chronic severe poisoning. Appendix A of this standard is an informative appendix.
This standard was proposed and returned by the Ministry of Health of the People's Republic of China. This standard was drafted by the Institute of Occupational Health and Poison Control of the Chinese Center for Disease Control and Prevention, and the participating drafting units include Peking University Third Hospital, Xinxiang Institute of Occupational Disease Prevention and Control, and Zhuzhou Zhishen Refinery Workers Hospital. This standard is interpreted by the Ministry of Health of the People's Republic of China. ..com Occupational cadmium poisoning diagnosis standard
GBZ17-2002
Occupational cadmium poisoning is mainly caused by inhaling cadmium compound smoke and dust. Acute poisoning is mainly manifested by respiratory damage; chronic poisoning causes kidney damage mainly with renal tubular lesions, and can also cause changes in other organs. 1 Scope
This standard specifies the diagnosis and treatment principles of occupational cadmium poisoning. This standard applies to acute and chronic poisoning caused by occupational exposure to cadmium compound smoke and dust. The chronic poisoning part of this standard can also be used as a reference in the diagnosis and treatment of non-occupational poisoning. 2 Normative references
The clauses in the following documents become clauses of this standard through reference in this standard. For all dated referenced documents, all subsequent amendments (excluding errata) or revisions are not applicable to this standard. However, the parties to the agreement based on this standard are encouraged to study whether the latest versions of these documents can be used. For all undated referenced documents, the latest versions are applicable to this standard. GB/T16180
WS/T31
WS/T32
WS/T33
WS/T34
WS/T97
3 Diagnostic principles
Evaluation of the degree of disability caused by work-related injuries and occupational diseases of employeesDiagnostic standards for acute occupational chemical poisoningDiagnostic standards for respiratory diseasesDiagnostic standards for metal fume fever
Flame atomic absorption spectrometry for cadmium in urine
Graphite furnace atomic absorption spectrometry for cadmium in urineDifferential potentiometric dissolution determination method for cadmium in urineGraphite furnace atomic absorption spectrometry for cadmium in bloodSpectrophotometric determination method for creatinine in urinebZxz.net
According to the history of short-term high-concentration or long-term close occupational exposure, the clinical manifestations mainly characterized by respiratory system or kidney damage and urine cadmium determination, and reference to on-site hygiene investigation data, the diagnosis of acute or chronic cadmium poisoning can be made after differential diagnosis and exclusion of other similar diseases.
4 Observation object
Urinary cadmium is above 5umol/mol creatinine (5ug/g creatinine) for two consecutive times, and there is no clinical manifestation of chronic cadmium poisoning. 5 Diagnosis and classification standards
5.1 Chronic poisoning
5.1.1 Chronic mild poisoning
In addition to increased urine cadmium, there may be symptoms such as dizziness, fatigue, membrane sensory impairment, back and limb pain. When laboratory examinations find any of the following changes, it can be diagnosed as chronic mild cadmium poisoning. a) Urinary β2-microglobulin content is above 9.6umol/mol creatinine (1000μg/g creatinine): b) Urinary retinol binding protein content is above 5.1μmol/mol creatinine (1000ug/g creatinine). 5.1.2 Chronic severe poisoning
In addition to the manifestations of chronic mild poisoning, chronic renal insufficiency occurs, which may be accompanied by osteoporosis and osteomalacia. Acute cadmium poisoning
Acute mild poisoning
Inhaling high concentrations of cadmium oxide smoke in a short period of time, coughing, sputum, chest tightness, etc. will occur after a few hours or 1 day. The breath sounds of both lungs are rough, or there may be scattered dry and wet rales. Chest X-rays show increased, thickened, and extended lung textures, which are consistent with acute tracheobronchitis or acute peribronchitis.
2 Acute moderate poisoning
With one of the following manifestations:
Acute pneumonia:
Acute interstitial pulmonary edema.
Acute severe poisoning
With one of the following manifestations:
Acute alveolar pulmonary edema;
Acute respiratory distress syndrome.
6 Treatment principles
6.1 Treatment principles
1 Chronic poisoning
Symptom supportive treatment is the main treatment.
2 Acute poisoning
Should leave the scene quickly, keep quiet and rest in bed. The first aid principle is the same as that of internal medicine. Short-term high-dose glucocorticoids should be given early as needed.
6.2 Other treatments
6.2.1 The subject of observation
Should be closely observed and reviewed once a year. 6.2.2 Chronic cadmium poisoning
Should be transferred away from cadmium contact and other harmful operations. Mildly poisoned patients can engage in other work; severely poisoned patients should be arranged to rest or take a full rest according to their condition. Those who need to undergo labor capacity assessment shall be treated in accordance with GB/T16180. 1
Acute cadmium poisoning
After the mildly poisoned patients recover, they can generally rest for 1~2 weeks before returning to work. The rest time of patients with severe poisoning can be appropriately extended. Instructions for the correct use of this standard
See Appendix A (Informative Appendix).
Appendix A
(Informative Appendix)
Instructions for the correct use of this standard
A.1 This standard applies to various occupational exposure to cadmium and its compounds, such as smelting of metal cadmium and cadmium-containing alloys, welding, nickel-cadmium battery manufacturing, pigment manufacturing, cadmium plating on metal surfaces, etc. Chronic cadmium poisoning caused by gastrointestinal ingestion also mainly causes kidney damage, so the chronic poisoning part of this standard can also be used as a reference in the diagnosis and treatment of non-occupational poisoning. A.2 The diagnosis and treatment of metal fume fever caused by exposure to cadmium oxide smoke can refer to GBZ48, which should be differentiated from chemical tracheobronchitis or peribronchitis caused by acute cadmium poisoning, and be alert to the occurrence of chemical pneumonia and pulmonary edema, see GBZ73. A.3 Patients with acute moderate and severe cadmium poisoning may suffer from liver and kidney damage, but before liver and kidney damage, there is usually obvious lung damage, so liver and kidney damage is not listed as the basis for diagnosis and classification of acute poisoning. A.4 Urinary cadmium is mainly related to the amount of cadmium load in the body and renal concentration, and can be used as a biomarker for occupational cadmium exposure and cadmium absorption. According to surveys, when urine cadmium reaches 5~10umol/mol creatinine, the prevalence of abnormal renal tubular function can reach 5%~20%, so 5umol/mol creatinine is used as the lower limit of diagnosis for chronic poisoning of current workers. In chronic cadmium poisoning, urine cadmium usually exceeds this value, and it can be reduced for those who have been out of contact for a long time, but it should be higher than the upper limit of the local normal reference value. A.5 Urinary cadmium determination includes flame atomic absorption spectrometry (WS/T31), graphite furnace atomic absorption spectrometry (WS/T32), differential potentiometric dissolution determination (WS/T33), etc. This standard does not make mandatory provisions, and local areas can choose one according to conditions. A.6 Blood cadmium mainly reflects the amount of recent exposure. Since the quantitative relationship between the recent absorption of cadmium and the blood cadmium concentration has not yet been established, the data on the dose-response relationship between blood cadmium and renal function abnormalities are far less than those on urine cadmium. Therefore, blood cadmium is not listed as a diagnostic indicator for chronic cadmium poisoning in this standard. However, in acute cadmium poisoning, increased blood cadmium can be used as evidence of excessive exposure to cadmium. The graphite furnace atomic absorption spectrometry method for blood determination can refer to WS/T34.
A.7 In addition to kidney damage, chronic cadmium poisoning can also affect other organs, but it is less common and lacks specificity, so the diagnosis is mainly based on kidney damage.
A.8 In the kidney damage of chronic cadmium poisoning, the recognized early change is mainly the decline of proximal tubular reabsorption function, so this standard takes tubular proteinuria as the starting point for diagnosis. At present, the main basis for diagnosis is the increased excretion of low molecular weight proteins such as urinary β2-microglobulin and retinol binding protein. There are two main methods for measuring urinary β2-microglobulin and retinol binding protein: radioimmunoassay and enzyme-linked immunosorbent assay. Local areas can choose one according to their own conditions. A.9 The determination of urinary cadmium, urinary β2-microglobulin and retinol binding protein mostly uses point sampling specimens, which are easily affected by the dilution of urine. Therefore, the concentrations of the above-mentioned urine test substances need to be corrected with urine creatinine (the determination method can be found in WS/T97). Urine samples with creatinine concentrations less than 0.3g/L or greater than 3.0g/L should be retested. A.10 When the disease develops to chronic renal insufficiency, which may be accompanied by osteoporosis and osteomalacia, it is already severe poisoning, and its diagnostic basis is the same as other related clinical disciplines.
A,11 Chronic cadmium poisoning should be differentiated from kidney diseases caused by various other reasons, poisoning by drugs and other industrial poisons, overflow proteinuria, Wilson's disease, idiopathic Fanconi syndrome, osteoporosis and softening caused by malnutrition, etc. A.12 Acute and chronic cadmium poisoning are mainly treated with symptomatic support. Since the effect of calcium sodium edetate is not significant, it can cause cadmium to be redistributed in the body in chronic poisoning, increase the amount of renal cadmium accumulation, and aggravate kidney disease. Therefore, it is not recommended to use calcium sodium edetate and other excretion drugs.
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