This standard specifies the diagnostic criteria and treatment principles for occupational chronic thallium poisoning. This standard applies to the diagnosis and treatment of occupational chronic thallium poisoning, and can also be used as a reference for the diagnosis of non-occupational chronic thallium poisoning. GBZ 87-2002 Occupational chronic thallium poisoning diagnostic criteria GBZ87-2002 Standard download decompression password: www.bzxz.net

ICS13.100
National Occupational Health Standard of the People's Republic of China GBZ87-2002
Diagnostic Criteria of Occupational Chronic Thallium Poisoning2002-04-08 Issued
2002-06-01 Implementation
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". In occupational activities with long-term exposure to thallium, chronic thallium poisoning is often caused by improper protection. In order to protect the health of the contactors and facilitate the prevention and control of thallium poisoning, this standard is formulated. This standard highlights the clinical significance of chronic exposure to thallium on the nervous system, especially the peripheral nervous system, and mainly conducts diagnostic classification based on its degree. Specific provisions are also made for the role of other common clinical manifestations of chronic thallium poisoning, such as hair loss and optic nerve damage, in diagnosis.
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. This standard was drafted by the Jiangxi Provincial Institute of Labor Health and Occupational Disease Prevention and Control, and the Occupational Health and Poisoning Control Institute of the Chinese Center for Disease Control and Prevention and the Shanggao County Health and Epidemic Prevention Station of Jiangxi Province participated in the drafting. This standard is interpreted by the Ministry of Health of the People's Republic of China. Occupational chronic poisoning diagnosis standard
GBZ87—2002
Occupational chronic thallium poisoning is a systemic disease with nervous system damage caused by long-term exposure to smoke, aerosols or soluble salts in occupational activities. 1 Scope
This standard specifies the diagnostic standard and treatment principles for occupational chronic thallium poisoning. This standard is applicable to the diagnosis and treatment of occupational chronic thallium poisoning, and can also be used as a reference for the diagnosis of non-occupational chronic thallium poisoning.
2 Normative references
The clauses in the following documents become the clauses of this standard through reference in this standard. For all dated references, all subsequent amendments (excluding errata) or revisions are not applicable to this standard. However, parties reaching an agreement based on this standard are encouraged to study whether the latest versions of these documents can be used. For all undated references, the latest versions are applicable to this standard.
GB/T16180
3 Diagnostic principles
Identification of the degree of disability caused by work-related injuries and occupational diseases of employees can be diagnosed only after the occupational history of long-term close contact with thallium, clinical manifestations such as nervous system damage and hair loss, combined with on-site hygiene survey data and urine thallium test results, and excluding similar diseases caused by other causes. 4Observation subjects
Those with any of the following:
a) Symptoms such as fatigue, lower limb weakness, and numbness of the limbs; b) Neuro-EMG shows suspected neurogenic damage without typical symptoms and signs of peripheral nerve damage; c) Increased urinary thallium
5Diagnosis and grading criteria
Mild poisoning
Those with any of the following:
a) Hyperalgesia of both heels and soles, symmetrical stocking-like distribution of pain, touch or tuning fork vibration sensation disorders in the lower limbs, and weakened Achilles tendon reflex;
b) The above manifestations are mild or not obvious, but the neuro-EMG shows neurogenic damage; c) Mild optic neuropathy or retinopathy;
d) Obvious hair loss.
5.2 Severe poisoningbzxZ.net
Those with any of the following:
Distal sensory impairment of the limbs, disappearance of the Achilles tendon reflex, accompanied by a significant decrease in limb muscle strength, affecting motor function: or a
distal muscle contraction of the limbs: electromyography shows neurogenic damage, accompanied by a significant slowing of nerve conduction velocity or a significant decrease in evoked potential: b) optic atrophy;
c) toxic encephalopathy;
d) toxic psychosis.
Treatment principles
Treatment principles
Disconnect from contact, use B vitamins and energy mixtures, and supplement with physical therapy, physical therapy and symptomatic treatment. The chelating agent dithiothioate can be used. Severe poisoning should also strengthen supportive therapy. 6.2 Other treatments
Observation subjects
Should be temporarily removed from the thallium working environment, and urine thallium should be rechecked after half a year, and neuro-electromyography examination should be performed as much as possible. After the urine thallium is reduced: the original work can be resumed.
6.2.2 Mild poisoning
After the mild poisoning patients recover after treatment, they should be transferred away from thallium work, but they can do other work and be reviewed regularly. 6.2.3 Severe poisoning
They should be transferred away from thallium and other jobs that are harmful to the nervous system. After treatment, they should be arranged to rest or work according to the examination results. Those who need to be assessed for the degree of disability caused by occupational diseases shall be handled in accordance with GB/T16180. 7. 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 Investigations have found that the opportunities for occupational exposure to thallium have increased, the onset is insidious, and the degree of disability is serious. It is necessary to formulate diagnostic standards for occupational chronic thallium poisoning, which is also conducive to the diagnosis of the increasing number of daily thallium poisoning. The main clinical manifestations of chronic thallium poisoning are peripheral neuropathy, optic neuropathy, retinopathy and alopecia. A few may develop toxic encephalopathy or toxic psychosis. A.2 The clinical manifestations of peripheral neuropathy caused by chronic poisoning are roughly similar to those of other toxic peripheral neuropathies. Its characteristic is that the hyperalgesia of the lower limbs, especially the heels and soles, is more prominent in the early stage. A.3 Optic neuropathy and retinopathy are one of the important clinical manifestations of thallium poisoning. Although the incidence rate is not very high, the onset is insidious and the degree of disability is serious. At first, it is only a decrease in vision and is not noticed by the patient. Close observation should be made and vision and visual field examinations should be performed regularly. Early manifestations include decreased vision in both eyes that cannot be corrected, peripheral visual field defects, central or paracentral scotoma, retinal edema, exudation, etc.: optic nerve atrophy occurs in severe cases. A.4 Alopecia is a common clinical manifestation of thallium poisoning. Its characteristic is that the hair falls off in bundles, and it can be completely bald or alopecia areata in a short period of time. Often even eyebrows, beards, armpit hair and pubic hair can fall off or be easily pulled out, and the prognosis is good. Not all poisoned patients experience hair loss, and those who experience hair loss do not all experience other symptoms of poisoning. However, it is difficult to distinguish hair loss alone from hair loss caused by other reasons. When the diagnosis is difficult, increased urine is a strong evidence. A.5 The normal reference value and determination method of urine thallium have not yet been unified, and there are still problems in the standardization of methods and quality control. Studies have shown that urine thallium can be elevated in contacts, and most poisoned patients have a significant increase in urine thallium. It is now preliminarily defined that urine thallium 5ug/L (atomic absorption spectrometry) is the upper limit of the normal value, that is, in the process of biological monitoring of contacts, urine thallium determination is generally used as an indicator of excessive exposure, and urine above 5ug/L should be listed as an observation object. Urine armor determination is also an important reference indicator for etiology identification.
Cases of poisoning caused by hidden contact are more difficult to diagnose. Close observation should be made, and urine thallium should be rechecked multiple times to make a clear diagnosis.
A.7 There is no specific treatment for chronic poisoning. Oral administration of disuccinic acid can be used, and the symptoms may improve to a certain extent. However, its exact efficacy needs to be further summarized and evaluated.
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