This standard specifies the diagnostic criteria and treatment principles for occupational acute chlordimeform poisoning. This standard applies to acute poisoning caused by exposure to chlordimeform in occupational activities. The diagnosis of acute poisoning caused by exposure to chlordimeform and its similar compounds such as monoformamidine and amitraz in non-occupational activities can also refer to this standard. GBZ 46-2002 Occupational acute chlordimeform poisoning diagnostic criteria GBZ46-2002 Standard download decompression password: www.bzxz.net

ICS13.100
National Occupational Health Standard of the People's Republic of China GBZ46-2002
Diagnostic Criteria of Occupational Acute Chlordimeform Poisoning2002-04-08 Issued
Ministry of Health of the People's Republic of China
Implementation on 2002-06-01
Article 5.1 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 GB11513-1989 is inconsistent with this standard, this standard shall prevail. Acute insecticide poisoning can be caused in occupational activities involving contact with a large amount of insecticides. In order to protect the health of the contactors, the state promulgated GB11513-1989 in 1989. Over the past decade, clinical studies on insecticide poisoning have shown great progress in cardiovascular damage. This revision has made corresponding additions in the diagnostic classification of acute insecticide poisoning, and based on the principle of the identity of target organ damage of occupational diseases, the relevant provisions in the Diagnostic Standards for Occupational Acute Chemical Poisoning Heart Disease are cited for implementation, and the description of the relationship between the standard and the appendix is ​​added to make the diagnostic classification clearer, more reasonable and easier to use. 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 is drafted by Huashan Hospital Affiliated to Fuzhou University and the Labor Health Teaching and Research Section of the School of Public Health of Fuzhou University. This standard is interpreted by the Ministry of Health of the People's Republic of China. Occupational Acute Insecticide Poisoning Diagnostic Standard GBZ46-2002
Occupational acute insecticide poisoning refers to a systemic disease with impaired consciousness, methemoglobinemia and hemorrhagic cystitis as the main manifestations caused by short-term exposure to a large amount of insecticides in occupational activities. There may be a range of heart damage
This standard specifies the diagnostic criteria and treatment principles for occupational acute insecticide poisoning. This standard applies to acute poisoning caused by exposure to insecticides in occupational activities. The diagnosis of acute poisoning caused by exposure to insecticides and their similar compounds such as monomethoxyamine and dimethoxyamine in non-occupational activities can also refer to this standard. 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 chemical poisoning heart disease diagnosis criteria Occupational acute chemical poisoning blood system disease diagnosis criteria Occupational acute chemical poisoning nervous system disease diagnosis criteria Based on the occupational history of short-term exposure to large amounts of insecticides, typical clinical manifestations, blood methemoglobin saturation test results, and reference to the determination of insecticides and their metabolites 4-chloro-o-toluidine in urine, exclude similar diseases caused by other causes, and make a comprehensive analysis before diagnosis.
4 Diagnosis and grading standardsbZxz.net
4.1 Mild poisoning
Symptoms include dizziness, headache, fatigue, chest tightness, nausea, and drowsiness, with blood methemoglobin accounting for 30% of the total hemoglobin; or chemical cystitis, with microscopic hematuria; or mild toxic heart disease, such as first-degree atrioventricular block, mild ST-T changes, frequent premature beats, etc. 4.2 Moderate poisoning
Has one of the following conditions:
a) Light coma;
b) Blood methemoglobin accounts for 30%-50% of the total hemoglobin; c) Moderate toxic heart disease, such as atrial fibrillation or flutter, IⅡI degree atrioventricular block, myocardial damage changes, etc.; d) Chemical cystitis, with symptoms of frequent urination, urgency, and pain when urinating, accompanied by hematuria. 4.3 Severe poisoning
In addition to the aggravation of the above symptoms, one of the following conditions exists: a) Deep coma;
b) Blood methemoglobin exceeds 50% of the total hemoglobin; c) Continuous slow heart rate, hypotension, shock; d) Severe toxic heart disease, such as ventricular fibrillation or flutter, I, III, I degree atrioventricular block, cardiogenic shock or congestive heart failure, sudden cardiac death, etc.
Treatment principles
5.1 Treatment principles
5.1.1 Immediately leave the scene, take off the contaminated clothes, and wash the contaminated skin with soapy water. Vitamin C and glucose solution are intravenously dripped or pushed. 5.1.2
5.1.3 For obvious purple, add 1~2mg/kg of methylene blue (methylene blue) to 50% glucose solution and push it slowly intravenously. If necessary, repeat half the amount once.
5.1.4 Patients with hemorrhagic cystitis should be given 5% sodium bicarbonate solution by intravenous drip, or they can be taken orally. 5.1.5 Patients with cardiovascular dysfunction should use catecholamine cardiotonic drugs (such as dopamine, metaraminol, etc.) to correct shock, and give drugs to correct heart rate disorders and myocardial nutrients. 5.1.6 The first aid treatment for coma is the same as that for internal medicine.
5.2 Other treatments
Acute poisoning patients can generally resume their original work after recovery. 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 For the damage to "nervous system, heart, etc." mentioned in the poisoning diagnosis and classification standards, refer to GBZ76, GBZ74, and GBZ75 respectively when actually applying the standard provisions. A.2 The percentage of methemoglobin to total hemoglobin is significantly positively correlated with the degree of purpura. When severe purpura occurs, it needs to be differentiated from purpura caused by hypoxia and peripheral circulatory failure. A.3 Chemical cystitis appears later than impaired consciousness and purpura. Mild cases may have no bladder irritation symptoms, only microscopic hematuria. Moderate poisoning patients may have bladder irritation symptoms accompanied by hematuria; severe patients may have obvious macroscopic hematuria, and even blood clots in the bladder, which may block the urethra
A.4 In recent years, clinical observations have found that cardiovascular dysfunction is obvious in cases of death from severe poisoning. Patients may die of refractory cardiogenic shock combined with supraventricular tachycardia, torsade de pointes or ventricular fibrillation. A.5 This type of pesticide stimulates central catecholamine receptors, and through negative feedback, the production and release of catecholamines are greatly reduced, so the content of catecholamine metabolites 3-methoxy-4-hydroxymandelic acid (VAM) in the blood and urine of exposed people can be significantly reduced. Units with conditions can use the determination of VAM content in blood and urine as an indicator of contact effect. A.6 The main metabolite of insecticide in the body is 4-chloro-o-toluidine. Its analogue, dimethylbenzene, is dimethylaniline. Determination of the content of the original drug or its metabolites can be used as a reference indicator for exposure and diagnosis of this type of pesticide. Since the experimental method requires a long time to operate, it is not included in the diagnostic indicator.
A.7 Treatment
A.7.1 Methylene blue is only used when methemoglobinemia occurs. If it is caused by hypoxia or peripheral circulatory failure, methylene blue should not be used.
A.7.2 The chemical structure of insecticide is similar to lidocaine. When poisoned patients have cardiovascular dysfunction, especially severe arrhythmia, lidocaine should not be used to correct the rhythm: isoproterenol-like drug diluent can be used for intravenous drip or cardiac pacing.
A.7.3 The dosage of vitamin C is generally 2~4g/day, diluted and intravenously dripped. Excessive dosage can cause hemolytic anemia. A.7.4 Before oral poisoning, gastric lavage should be performed promptly and thoroughly.
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