GBZ 43-2002 Diagnostic criteria for occupational acute pyrethroid poisoning
Some standard content:
ICS13.100
National Occupational Health Standard of the People's Republic of China GBZ43—2002
Diagnostic Criteria of Occupational Acute Pyrethroids PoisoningPublished on April 8, 2002
Implemented on June 1, 2002
Ministry of Health of the People's Republic of China
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 there is any inconsistency between the original standard GB11510-1989 and this standard, this standard shall prevail. Pyrethroids are widely used insecticides in my country, and their production and use are second only to organophosphorus insecticides. In occupational activities, acute poisoning may occur if exposed to high concentrations or large amounts of cyanide-containing pyrethroids in a short period of time. For this reason, my country promulgated GBI1510-1989 in 1989. In the 10 years since the implementation of this standard, the number of cases of acute occupational poisoning caused by the mixture of pyrethroids and organophosphorus insecticides has increased year by year; the writing format of the occupational disease diagnosis standard has new unified requirements and therefore needs further revision
Appendix A of this standard is an informative appendix, and Appendix B is a normative appendix. This standard is proposed and managed by the Ministry of Health of the People's Republic of China. This standard is drafted by the Occupational Health and Poison Control Institute of the Chinese Center for Disease Control and Prevention. The participating units include the Shandong Provincial Institute of Labor Health and Occupational Diseases. This standard is interpreted by the Ministry of Health of the People's Republic of China. Occupational Acute Pyrethroid Poisoning Diagnostic Standard GBZ43-2002
Occupational acute pyrethroid poisoning is a systemic disease with abnormal excitability of the nervous system as the main manifestation due to close contact with a large amount of pyrethroid insecticides in a short period of time during occupational activities. 1 Scope
This standard specifies the diagnostic criteria and treatment principles for pyrethroid poisoning. This standard applies to the diagnosis and treatment of acute poisoning caused by cyanide-containing pyrethroid insecticides (such as deltamethrin, cypermethrin, cypermethrin, etc.) in occupational activities. This standard can also be used for 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, 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.
3 Diagnostic principles
Occupational acute organophosphorus pesticide poisoning diagnostic criteria Occupational contact dermatitis diagnostic criteria
Occupational acute chemical poisoning diagnostic criteria (general) Occupational acute chemical poisoning nervous system disease diagnostic criteria Based on the occupational history of close contact with a large amount of pyrethroids in a short period of time, the clinical manifestations mainly characterized by abnormal excitability of the nervous system appear, combined with on-site investigation, comprehensive analysis, and exclusion of other diseases with similar clinical manifestations before diagnosis can be made. 4 Contact reaction
Abnormal facial sensation (burning, tingling or tight numbness), skin and mucous membrane irritation symptoms after contact, but no obvious systemic symptoms.
5 Diagnosis and classification standards
5.1 Mild poisoning
In addition to the above clinical manifestations, obvious systemic symptoms include headache, dizziness, fatigue, loss of appetite, nausea, vomiting, mental depression, increased oral secretions, or fasciculations. 5.2 Severe poisoning
In addition to the above clinical manifestations, patients with any of the following can be diagnosed as severely poisoned: a) Paroxysmal seizures;
b) Severe disturbance of consciousness;
Pulmonary edema.
Treatment principles
6.1 Treatment principles
6.1.1 Immediately leave the accident scene. If there is skin contamination, wash it thoroughly with soapy water or other alkaline liquids or clean water. Acute poisoning is mainly treated symptomatically, and supportive therapy should be strengthened for patients with severe poisoning (see GBZ71). 6.1.2
Acute poisoning of pyrethroids and organophosphorus mixed insecticides should be treated according to the treatment principles of acute organophosphorus insecticide poisoning, and then given corresponding symptomatic treatment. 6.2 Other treatments
After mild poisoning is cured, the patient can resume the original work. 6.2.1
Severely poisoned people should be arranged to rest according to their condition and can resume their original work after recovery. 6.2.2
For instructions on the correct use of this standard
See Appendix A (Informative Appendix).
A.1 Scope of application of this standard
Appendix A
(Informative Appendix)
Instructions on the correct use of this standard
This standard applies to acute poisoning caused by exposure to high concentrations or large amounts of α-cyano pyrethroid insecticides (such as deltamethrin, cypermethrin, cypermethrin, etc.) in occupational activities. Non-occupational poisoning people can also refer to this standard.
In insecticides mixed with pyrethroids and organophosphorus, because the toxicity of the organophosphorus components is generally higher than that of the pyrethroid components, "the clinical manifestations of acute poisoning caused by the mixture are often similar to those of acute organophosphorus poisoning. Therefore, acute poisoning caused by the mixture of pyrethroids and organophosphorus insecticides needs to be diagnosed with reference to GBZ8. A.2 Different varieties of α-cyano-containing pyrethroid insecticides cause basically similar adverse reactions and poisoning symptoms to occupational contacts. Among the adverse reactions after contact, abnormal facial sensation is more common, and most of them recover more than 24 hours after stopping contact, and may be accompanied by symptoms of eye and nasal mucosal irritation. Contaminated mucous membranes (such as eyes and perineum) can cause local redness and swelling, and some beneficiaries may develop erythema, papules and bullae on the skin. These contact The manifestations of dermatitis (see GBZ20) are not necessarily related to whether or not there is poisoning. A correct judgment can only be made based on systemic clinical manifestations, combined with a comprehensive analysis of occupational history, on-site investigations, and related tests.
A.3 For those with mild acute pyrethroid poisoning in production, the first symptom is often abnormal sensations on the face. Although the systemic symptoms are mainly neurological symptoms, they lack specificity and can usually be recovered after breaking contact and resting for 2 to 6 days. It is rare for people with oral pyrethroid poisoning to have abnormal facial sensations. The first symptoms are often nausea, vomiting, and upper abdominal pain. A.4 For the classification and grading of disturbances of consciousness in severe poisoning, please refer to Appendix D in GBZ76. A.5 Abnormal facial sensations (numbness, burning sensation) in those who have contact reactions ), fasciculation that occurs in mild poisoning, and paroxysmal twitching that occurs in severe poisoning (rigidity of limbs, opisthotonos, and unconsciousness during attacks) are all manifestations of increased excitability of peripheral or central nervous systems. If conditions permit, paired electrical stimulation of the nerve-electromyogram can be used to check whether there is increased excitability of peripheral nerves or repeated muscle discharges; or an electroencephalogram can be performed to observe whether there are repeated discharges in the brain, but a negative result cannot rule out the diagnosis of poisoning. wwW.bzxz.Net
A.6 In the differential diagnosis of this disease, diseases such as upper respiratory tract infection, heat stroke, food poisoning or acute poisoning by other pesticides should be excluded. Because the smell of pyrethroids is similar to that of organophosphorus, it should be differentiated from organophosphorus insecticide poisoning. In addition to the history of contact, the erythrocyte cholinesterase activity of those with acute pyrethroid poisoning is mostly positive. Usually, atropine test treatment can be performed. Most people with acute pyrethroid poisoning cannot tolerate atropine treatment of more than 5 mg, and recover in 2 to 6 days after symptomatic treatment, with a good prognosis. A.7 Pyrethroids are metabolized and excreted very quickly in the human body. The original compound in urine can be detected within 24 hours after contact, and some metabolites can be detected within 3 to 5 days. The content of cypermethrin prototype can be detected by gas chromatography, or the metabolites of cyanamide (Br2A) and cypermethrin (CIA) in urine can be detected by high pressure liquid chromatography, or the metabolites of cyfluthrin (cyfluthrin) can be determined by capillary gas chromatography combined with mass spectrometry. Fluorophoxybenzoic acid (fluorophenoxybenzoic acid) can be used as an exposure indicator. No parallel relationship has been found between the detection amount and the reaction of the contact person. A.8 Pyrethroid vinegar can be decomposed when it encounters alkali, so the contaminated skin should be washed with soapy water as much as possible. For those who are poisoned by oral administration, it is also advisable to thoroughly wash the stomach with 2% to 4% sodium bicarbonate solution or clean water. Warm water can aggravate abnormal sensations of the skin, so it should be avoided. For those with contact dermatitis, please refer to GBZ20 for treatment. There is no antidote for acute pyrethroid poisoning so far, and the prognosis is generally good after symptomatic and supportive treatment. 9 When pyrethroids and organophosphorus pesticides cause acute poisoning, the toxicity of organophosphorus pesticides is significantly higher than that of A.9
Pyrethroids, the clinical manifestations of poisoning are generally similar to those of acute organophosphorus insecticide poisoning, so blood cholinesterase should be tested first, and the diagnosis should be made according to the diagnostic criteria for occupational acute organophosphorus insecticide poisoning. Treatment should first use drugs such as atropine and cholinesterase reactivators, and then symptomatic treatment. When organophosphorus insecticide poisoning cannot be ruled out, an appropriate amount of atropine can be used for trial treatment, and the treatment response should be closely observed. For patients with severe pyrethroid poisoning and pulmonary edema, a small amount of atropine can be used for treatment, but care should be taken to avoid excessive atropine poisoning.
The requirements for health examinations for those who are occupationally exposed to mixed pyrethroids and organophosphorus insecticides include, in addition to internal medicine and neurology A.10
examinations, whole blood or red blood cell cholinesterase activity should also be checked for the effects of organophosphorus.
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