GBZ 44-2002 Diagnostic criteria for occupational acute arsenic poisoning
Some standard content:
ICS13.100
National Occupational Health Standard of the People's Republic of China GBZ44-2002
Diagnostic Criteria of Occupational Acute Arsine 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 GB11511-1989 is inconsistent with this standard, this standard shall prevail. Arsine is the waste gas produced when arsenic-containing metal slag meets acid or its hot waste slag meets water. In occupational activities, accidents or improper protection often cause acute poisoning of contacts. The revised standard is based on the principle of linking with the relevant parts of the "Diagnostic Standards for Occupational Acute Chemical Poisoning" and highlighting the characteristics of acute hydrogen poisoning itself. The relevant contents of the diagnostic indicators and treatment principles in the original standard have been modified and supplemented to make it clearer, more reasonable and easier to apply. Appendix A of this standard is an informative appendix.
This standard is proposed and managed by the Ministry of Health of the People's Republic of China. The responsible drafting units of this standard: Shanghai Chemical Industry Occupational Disease Prevention and Control Institute, Shanghai Zhabei District Central Hospital. Participating drafting units: Peking University Third Hospital, Shenyang Labor Health Occupational Disease Research Institute, Shanxi Occupational Disease Hospital, Zhejiang Provincial Center for Disease Control and Prevention, Lanzhou Baiyin Company Labor Research Institute, Gansu Province, Shanghai Occupational Disease Hospital, Yunnan Occupational Disease Prevention and Control Institute. The Ministry of Health of the People's Republic of China is responsible for interpreting this standard. Occupational acute arsenic poisoning diagnostic criteria GBZ44-2002
Occupational acute arsenic poisoning refers to a systemic disease characterized by acute intravascular hemolysis caused by inhalation of high concentrations of arsenic gas in a short period of time during occupational activities. In severe cases, acute renal failure may occur. 1 Scope
This standard specifies the diagnostic criteria and treatment principles for occupational acute arsenic poisoning. This standard applies to acute poisoning caused by inhalation of arsenic gas during occupational activities. It does not apply to poisoning caused by arsenic, arsenic oxides and arsenates.
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 an 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 shall apply to this standard.
GB/T16180
3 Diagnostic principlesbZxz.net
Diagnostic criteria for occupational acute chemical poisoning blood system diseases Diagnostic criteria for occupational acute toxic nephropathy Evaluation of the degree of disability caused by work-related injuries and occupational diseases of employees Based on the occupational history of inhaling high concentrations of hydrogen arsenide gas in a short period of time and the clinical manifestations of acute intravascular hemolysis, combined with relevant laboratory test results, and reference to on-site labor hygiene survey data, comprehensive analysis, and exclusion of similar diseases caused by other causes, a diagnosis can be made.
4 Contact reaction
Symptoms such as fatigue, dizziness, headache, nausea, etc., disappear quickly after the contact is broken. 5 Diagnosis and classification standards
5.1 Mild poisoning
There are often chills, fever, headache, nausea, back pain, and soy sauce-colored urine, sclera and skin yellowing and other clinical manifestations of acute intravascular hemolysis: peripheral blood hemoglobin, urine occult blood test and other intravascular hemolysis laboratory tests are abnormal, and the urine volume is basically normal. It is consistent with mild toxic hemolytic anemia, and may be followed by mild toxic nephropathy. 5.2 Severe poisoning
The onset is rapid, with chills, fever, obvious back pain or abdominal pain, dark brown urine, oliguria or anuria, obvious yellowing of the sclera and skin, and bronze or purple-black skin in extremely severe hemolysis, which is consistent with severe toxic hemolytic anemia and may cause impaired consciousness. Peripheral blood hemoglobin is significantly reduced, urine occult blood test is strongly positive, and plasma or urine free hemoglobin is significantly increased. Blood creatinine increases progressively, and moderate to severe toxic nephropathy may be secondary. 6 Treatment principles
6.1 Treatment principles
6.1.1 In the event of an accident, all contacts should leave the scene quickly. 6.1.2 Contact reactions should be closely observed for 48 hours, rest quietly, encouraged to drink water, take alkaline drugs orally, and monitor urine routine and urine occult blood tests.
6.1.3 All poisoned patients should be hospitalized for treatment, and glucocorticoids should be used in sufficient quantities for a short period of time in the early stage, and fluid infusion should be given in the early stage. Diuretics should be used correctly to maintain urine volume and alkalize urine. Drugs with strong nephrotoxicity should be avoided. For patients with severe poisoning, blood purification therapy should be used as soon as possible; according to the degree and speed of hemolysis, exchange transfusion therapy can be used if necessary; and attention should be paid to maintaining water and electrolyte balance, ensuring sufficient calories and other symptomatic supportive treatments.
6.2 Other treatments
Mild poisoning can be restored to the original work after recovery; patients with severe poisoning who develop acute renal failure should be considered for transfer from harmful work depending on the recovery of the disease. If labor capacity assessment is required, refer to the relevant provisions of GB/T16180 for processing. 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 The diagnostic classification of this standard is mainly based on acute intravascular hemolysis and the degree of acute renal damage caused by it. A.2 The contact reaction is only symptoms such as fatigue, without common clinical manifestations of acute intravascular hemolysis such as urine color change and sclera and skin yellowing, and the laboratory tests related to intravascular hemolysis are all normal. A.3 Acute intravascular hemolysis is the starting point for diagnosis, and its diagnosis is based on clinical manifestations and laboratory test indicators. Soy sauce-colored urine (the urine color may be red tea color in the early stage of hemolysis), and there are characteristic clinical manifestations of intravascular hemolysis such as vomiting, back pain or abdominal pain, sclera and skin yellowing. Laboratory tests found that peripheral blood hemoglobin decreased, urine occult blood test was positive, and plasma or urine free hemoglobin increased. Soy sauce-colored urine is a clear reflection of the presence of hemoglobinuria. Although it is not the earliest manifestation of free hemoglobinemia, it appears earlier after poisoning and is one of the more practical and easy-to-operate starting indicators for the diagnosis of hemolysis. Increased reticulocytes, increased serum indirect bilirubin, and increased urobilinogen can be used as diagnostic reference indicators. A.4 During the course of the disease, attention should be paid to the dynamic observation of peripheral blood hemoglobin, plasma or urine free hemoglobin, urine occult blood, and urine color changes to determine the severity of hemolysis and whether hemolysis continues. Acute renal failure (ARF) is the most serious secondary disease of hemolysis. Its pathological changes are characterized by acute tubular necrosis (ATN). Patients all have oliguria or anuria, so urine volume can also be used as an indicator to determine the degree of renal damage caused by hemolysis and the prognosis of this disease. A.5 The occurrence of this disease is often sudden and hidden, and the early clinical manifestations are non-specific, which can easily lead to mixed diagnosis and misdiagnosis. It should be differentiated from diseases such as upper respiratory tract infection, acute gastroenteritis, urinary tract stones, acute viral hepatitis, cholecystitis and cholelithiasis. A.6 Acute intravascular hemolysis is self-limiting, and the hemolysis period generally does not exceed 5 days, with the peak being around the 3rd day. The focus of treatment is to protect renal function as soon as possible, to give reasonable fluid infusion in the early stage, and to use diuretics correctly to maintain urine volume, which is very important for protecting renal function. For patients with mild poisoning, 125ml-250ml of 20% mannitol can be intravenously dripped, which should be completed within 5-10 minutes, and the daily dosage should not exceed 750ml; for patients with severe poisoning, mannitol is generally not recommended, but furosemide diuretics are preferred, which can be used in combination with dopamine when necessary, and the effect is better. If the urine volume does not increase, it means that severe ATN has occurred, diuretic treatment is ineffective, diuresis should not be used again, and blood purification therapy is required. Blood purification therapy is the most effective method for rescuing critically ill patients and should be adopted as soon as possible. Patients who meet any of the following conditions are all indications for blood purification therapy: (1) The skin is obviously yellow or bronze or purple-black; (2) Diuretics are ineffective when the urine is oliguric or anuric; (3) Scr>442μmol/L (5mg/dl) or the daily increase is>44.2μmol/L (0.5g/dl). Hemodialysis is the most commonly used and effective method. When conditions are unavailable, peritoneal dialysis can also be used as an emergency measure to rescue severely poisoned patients.
For severely poisoned patients with acute onset and severe hemolysis, blood exchange therapy can also be used. It is emphasized that the blood exchange time should be early and should not exceed 48 hours after poisoning. The total amount of blood exchange is generally more than 50% of the total blood volume of the human body. A.7 Hydroxyl chelating agents cannot prevent the progression of this disease and are generally not used. A.8 Preleukemic clinical studies have listed serum haptoglobin and glomerular filtration rate as specific and sensitive indicators for the early diagnosis of acute intravascular hemolysis and ARF. Therefore, those who have the conditions can choose the above indicators to provide data for the future revision of this standard.
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