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GB17059—1997
Contact with yellow phosphorus in occupational activities can cause acute or chronic poisoning. There are both connections and differences between the two, and the pathogenesis and clinical manifestations are different. This standard is specially formulated to protect the health of the contactors, standardize the diagnosis of phosphorus poisoning, and effectively prevent and treat phosphorus poisoning. This standard stipulates the diagnosis and treatment principles of acute and chronic phosphorus poisoning. The various rules stipulated in this standard are only applicable to yellow phosphorus, not to red phosphorus, purple phosphorus and black phosphorus. Based on the principles of uniformity of occupational disease diagnosis rules, the same target organ damage of exogenous diseases, and consistency of clinical manifestations, this standard refers to the diagnosis and classification standards in GB19379--1996 "Diagnosis Criteria and Treatment Principles of Occupational Toxic Liver Disease" and GB19371-1996 "Diagnosis Criteria and Treatment Principles of Occupational Chemical Skin Burns" when compiling the diagnosis criteria for acute phosphorus poisoning with chemical liver damage as the main clinical manifestation; in the differential diagnosis points and routine functional tests of acute and chronic liver diseases, this standard is also implemented with reference to this standard. This standard is based on the industry advantage that people working in occupational hazards have health records and are systematically followed up. In order to make a good differential diagnosis of diseases, especially when the early clinical manifestations of poisoning are difficult to distinguish from common diseases, the diagnostic classification standard of chronic phosphorus poisoning is compiled with the guiding ideology of special observation for special populations and finding the relationship between progressive changes in diseases and continuous exposure. This standard shall be implemented from December 1, 1998. Appendix A of this standard is the appendix of the standard. Appendix B of this standard is the appendix of the suggestion.
This standard is proposed by the Ministry of Health of the People's Republic of China. This standard is drafted by the Liaoning Provincial Institute of Labor Health and Occupational Disease Prevention and Control and the Yantai Municipal Institute of Occupational Disease Prevention and Control of Shandong Province. The participating units are: Guangxi Zhuang Autonomous Region Institute of Occupational Disease Prevention and Control, Wuhan Chemical Industry Occupational Disease Prevention and Control Institute, Shandong Provincial Institute of Labor Health and Occupational Disease Prevention and Control, Shandong Zibo Municipal Institute of Occupational Disease Prevention and Control and the Department of Stomatology of Shandong Medical University. This standard is interpreted by the Chinese Academy of Preventive Medicine, the technical unit entrusted by the Ministry of Health. 245
National Standard of the People's Republic of China
Diagnostic criteria of occupational phosphorus poisoning
Diagnostic criteria of occupational phosphorus poisoningGB17059—1997
Occupational phosphorus poisoning refers to systemic diseases caused by workers' exposure to yellow phosphorus in their occupational activities. Acute phosphorus poisoning is caused by short-term exposure to large doses of yellow phosphorus or yellow phosphorus burns, with liver and kidney damage as the main manifestation; chronic phosphorus poisoning is caused by long-term exposure, with teeth and mandibular damage as the main manifestation, which may be accompanied by liver and kidney damage. 1 Scope
This standard specifies the diagnostic criteria and treatment principles for occupational phosphorus poisoning. This standard applies to poisoning caused by exposure to yellow phosphorus in occupational activities, and does not apply to poisoning caused by red phosphorus, purple phosphorus, black phosphorus, etc. This standard can also be used as a reference for poisoning caused by exposure to yellow phosphorus in non-occupational activities. 2 Referenced Standards
The provisions contained in the following standards constitute the provisions of this standard through reference in this standard. When this standard is published, the versions shown are valid. All standards will be revised, and parties using this standard should explore the possibility of using the latest versions of the following standards. GB16379-1996 Occupational toxic liver disease diagnosis criteria and treatment principles GB19371-1996 Occupational chemical skin burns diagnosis criteria and treatment principles 3 Diagnostic principles
3.1 According to the occupational history of inhaling a large amount of yellow phosphorus vapor or yellow phosphorus burns in a short period of time, there are clinical manifestations of acute liver and kidney damage, and comprehensive analysis and exclusion of similar diseases caused by other causes, it can be diagnosed as acute phosphorus poisoning. 3.2 According to the occupational history of long-term close contact with yellow phosphorus vapor or yellow phosphorus dust, there are clinical manifestations of progressive periodontal tissue, tooth and mandibular damage, and there may also be liver and kidney damage. Combined with on-site labor hygiene data, comprehensive analysis, and exclusion of similar diseases caused by other causes, it can be diagnosed as chronic phosphorus poisoning.
4 Diagnosis and classification standards
4.1 Acute phosphorus poisoning
4.1.1 Mild poisoning
Symptoms such as headache, dizziness, fatigue, loss of appetite, nausea, and pain in the liver area appear several hours after inhaling high-concentration yellow phosphorus vapor or about 1 to 10 days after yellow phosphorus burns, and there is liver enlargement and tenderness, accompanied by abnormal liver function tests, which is consistent with acute mild toxic liver disease; there may be hematuria, proteinuria, and tubular urine, which is consistent with acute mild toxic nephropathy. 4.1.2 Moderate poisoning
The above symptoms are aggravated, and one of the following conditions occurs: a) The liver is obviously enlarged and tender, and the liver function is obviously abnormal, which is consistent with acute moderate toxic liver disease; b) Renal insufficiency, increased urea nitrogen and plasma creatinine, which is consistent with acute moderate toxic nephropathy. 4.1.3 Severe poisoning
Approved by the State Administration of Technical Supervision on November 11, 1997 246
Implemented on December 1, 1998
GB17059-1997
On the basis of the above clinical manifestations, one of the following conditions occurs: a) Acute liver failure;
b) Acute renal failure.
4.2 Chronic phosphorus poisoning
4.2.1 Observation subjects
After long-term close contact with phosphorus vapor or yellow phosphorus dust, periodontal atrophy, deepening of periodontal pockets, loose teeth, etc., and X-ray of the mandible shows mild absorption of the alveoli on both sides, which are horizontal.
4.2.2 Mild poisoning
After clinical dynamic observation for more than one year, after symptomatic treatment, the above symptoms are progressively aggravated, alveolar bone absorption exceeds 1/3 of the root length, the periodontal ligament space widens, narrows or disappears, the bone plate thickens, and the bone texture in the mandibular body is thickened or sparse, and the arrangement is disordered; there may be respiratory mucosal irritation and digestive system symptoms.
4.2.3 Moderate poisoning
The above symptoms are aggravated, and symmetrical bone density shadows appear in the posterior tooth area of the mandible, with unclear perimeters, and the frontal foramen may be enlarged and the edges blurred. 4.2.4 Severe poisoning
On the basis of the above clinical manifestations, mandibular osteonecrosis or fistula formation occurs. 5 Treatment principles
5.1 Acute phosphorus poisoning
5.1.1 Etiological treatment
a) After inhaling high concentration of yellow phosphorus vapor, leave the scene quickly and move to a place with fresh air. b) After yellow phosphorus burns the skin, rinse with clean water immediately, extinguish the phosphorus fire, remove the yellow phosphorus particles embedded in the tissue, and prevent the absorption of yellow phosphorus. Refer to GB19371 for treatment.
5.1.2 Symptomatic and supportive treatment
a) Adrenocortical hormones, oxygen free radical scavengers, calcium channel blockers, etc. can be appropriately selected; b) Pay attention to maintaining water, electrolytes and acid-base balance; c) For toxic liver disease, use symptomatic treatment such as liver protection and nutritional therapy; d) For toxic nephropathy, pay attention to the prevention and treatment of hypovolemia, improve renal microcirculation and other symptomatic and supportive treatments, and blood purification therapy can be used when necessary.
5.2 Chronic phosphorus poisoning
5.2.1 Pay attention to oral hygiene, treat various oral diseases in time, and repair teeth as soon as possible; 5.2.2 Patients with mandibular necrosis or osteomyelitis should be given surgical treatment in time; 5.2.3 Pay attention to protecting liver and kidney functions, and give symptomatic treatment. 6 Labor capacity assessment
6.1 Acute phosphorus poisoning
After mild poisoning is cured, the worker should be temporarily transferred away from yellow phosphorus operations. After moderate and severe poisoning is cured, the worker should generally not engage in yellow phosphorus operations. 6.2 Chronic phosphorus poisoning
6.2.1 After mild poisoning is cured, the worker can engage in the original work. If the condition is progressively aggravated, the worker should be transferred away from yellow phosphorus operations. 6.2.2 Moderate and severe poisoning should be transferred away from yellow phosphorus operations. 7 Requirements for health examination
7.1 Pre-employment physical examinationwwW.bzxz.Net
All phosphorus workers should undergo a pre-employment physical examination. The items shall be in accordance with the requirements of the dental and internal medicine physical examination, including taking X-ray images of the left and right sides of the mandible at 247
GB17059-1997
and diseased teeth, blood and urine routine tests, liver and kidney function tests, etc. 7.2 Regular physical examination
Phosphorus workers shall undergo a physical examination once a year. The examination items can refer to the pre-employment physical examination items and establish a health record. 7.3 Those who are found to have periodontal and dental lesions should be actively treated. 8 Occupational contraindications
a) Obvious lesions of periodontium, tooth and jaw; b) Chronic liver and kidney diseases.
A1 Side view of mandible in sitting (standing) position
A1.1 Film 5×7 horizontally placed.
A1.2 Distance 55-60 cm.
GB17059—1997
Appendix A
(Appendix of the standard)
Requirements for X-ray examination of mandible
A1.3 Positioning method: The patient sits (stands) in the side position in front of the photography stand, with the mandible on the side to be examined close to the photography stand, with both arms placed beside the body, and the mandible placed on the dark box on the stand tilted 30° to the side to be examined. The forehead is extended forward, and the mandible on the side to be examined is parallel to the dark box as much as possible. The front edge of the dark box includes the mandibular joint, and the lower edge is flush with the lower edge of the mandible.
A1.4 The center line is tilted 30° toward the head and aligned with 5cm below the mandibular angle on the opposite side. A2 Supine side view of the lower jaw (this method can be used if there is no standing photography stand) A2.1 Film 5X7 is placed horizontally.
A2.2 Distance is 60cm.
A2.3 Positioning method: The patient lies on the photography table with his arms at his side and his head turned to the side to be examined. The opposite shoulder is raised with a pillow or sandbag. To avoid the overlap of the cervical spine and the mandible, the forehead is extended forward, and the body of the mandible on the side to be examined is laid flat and as parallel to the cassette as possible. The front edge of the cassette includes the mandibular joint, and the lower edge is aligned with the lower edge of the mandible. A2.4 The center line is tilted 30° toward the head and aligned with 5cm below the mandibular angle on the opposite side. A3 Darkroom requirements
The developer and fixer should be prepared according to the formula in the instructions of the X-ray film used. The development time is 4~~6min. The temperature of the liquid medicine is between 18 and 22 degrees Celsius.
A4 Film quality requirements
A4.1 According to the requirements of the X-ray film being developed, the mandibular body on the side being examined should be clearly displayed and should not be deformed (too wide or too narrow). The mandibular bone on the opposite side should not overlap, and 4 to 5 teeth should be displayed on the side being examined. A4.2 The structure of the teeth, periradicular and jawbone should be clearly displayed. A5 In chronic poisoning, both the upper and lower jaws can be damaged, but the mandibular bone is more common. If the diagnosis of the disease requires it, the teeth and maxillary images of the corresponding parts should be taken.
Appendix B
(Suggested Appendix)
Instructions for the correct use of the standard
B1 This standard applies to occupational acute and chronic poisoning caused by yellow phosphorus. Acute phosphorus poisoning is mainly caused by liver and kidney damage, and consciousness disorders may occur in severe poisoning; chronic poisoning is mainly caused by tooth and mandibular damage, which may be accompanied by liver and kidney damage. In clinical observation, the condition should be observed and evaluated from a holistic perspective, and attention should be paid to the damage of yellow phosphorus to multiple organs of the body. B2 Acute phosphorus poisoning
B2.1 Yellow phosphorus burns are often treated with 1% to 2% copper sulfate to clean the wound and extinguish phosphorus fire, but excessive use can cause acute copper poisoning and lead to hemolysis, so special attention should be paid to this side effect; it is now advocated to use 2% to 3% silver nitrate solution to clean until there is no phosphorus fire. B2.2 Yellow phosphorus poisoning can occur when the burn area is small, and liquid yellow phosphorus burns of 5% can be fatal. Pathological changes in organs such as liver and kidney may occur about 1 to 10 days after the burn, and these situations should be taken seriously; the grading indicators should be implemented according to the diagnostic steps and grading standards for acute toxic liver disease and kidney disease.
B2.3 Routine liver function test items in acute phosphorus poisoning can be tested in accordance with Appendix C5.1 of GB163791996. 249
GB17059-1997
B2.4 In acute phosphorus poisoning, renal function tests can include urea nitrogen, plasma creatinine, urine sodium and urine volume. B2.5 In acute phosphorus poisoning, blood phosphorus may increase and blood calcium may decrease, but since the test results are affected by other factors, they are not listed as classification indicators.
B2.6 This standard proposes the treatment principles for liver disease caused by acute phosphorus poisoning, which can be implemented with reference to GB16379. B3 Chronic phosphorus poisoning
B3.1 Chronic phosphorus poisoning currently lacks sensitive and specific diagnostic indicators, and cannot be diagnosed based on a single examination. Dynamic observation and treatment must be carried out to provide complete and comprehensive clinical data on the annual changes in teeth, jaws and liver after exposure to yellow phosphorus. Self-comparison, combined with occupational history and the results of yellow phosphorus concentration measurement in workshop air, comprehensive analysis and differential diagnosis can be made before a clear diagnosis can be made; patients with liver damage on the basis of oral diseases can be treated according to the relevant provisions of GB16379. B3.2 Periodontal, tooth and mandibular lesions of chronic phosphorus poisoning tend to occur in bilateral posterior teeth, often multiple teeth, often bilaterally symmetrical, mostly in the mandible. After more than one year of treatment, they still progress and worsen, and are often accompanied by respiratory mucosal irritation symptoms and digestive system symptoms. This can be distinguished from non-occupational oral diseases, because non-occupational oral diseases are mostly single or double teeth, and the location is not fixed and asymmetrical, and there are rarely other systemic symptoms.
B3.3According to domestic and foreign data, chronic phosphorus poisoning may cause liver and kidney damage. Since there are few cases, liver and kidney damage are not used as diagnostic classification standards for the time being. Although liver and kidney damage are rare, they cannot be ignored. Therefore, when conducting physical examinations on yellow phosphorus producers, attention should be paid to the overall health of the body, and health monitoring should be done if conditions permit.
B3.4 Chronic mild toxic liver disease liver function tests ALT, AST, etc. are often normal. Serum bile acid determination and indocyanine green retention test (ICG) are more sensitive. Renal function tests can be used for urine routine, urine protein quantification and urine sodium determination. Observation items can be selected according to clinical conditions. B4 Phosphorus has four allotropes, namely yellow phosphorus (also known as white phosphorus), red phosphorus (also known as red phosphorus), purple phosphorus, and black phosphorus. Among them, yellow phosphorus is the most toxic, and the others are very small. If the product is impure and contains yellow phosphorus, it may cause phosphorus poisoning. Therefore, the name of the allotrope containing yellow phosphorus should be indicated in brackets after diagnosis to distinguish poisoning caused by pure yellow phosphorus. 2503 According to domestic and foreign data, chronic phosphorus poisoning may cause liver and kidney damage. Because there are very few cases, liver and kidney damage is not used as a diagnostic classification standard for the time being. Although liver and kidney damage are rare, they cannot be ignored. Therefore, when conducting physical examinations on yellow phosphorus producers, attention should be paid to the overall health of the body, and health monitoring should be done if conditions permit.
B3.4 Chronic mild toxic liver disease Liver function tests such as ALT and AST are often normal. Serum bile acid determination and indocyanine green retention test (ICG) are more sensitive. Renal function tests can be performed using urine routine, urine protein quantification and urine sodium determination. Observation items can be selected based on clinical conditions. B4 Phosphorus has four allotropes, namely yellow phosphorus (also known as white phosphorus), red phosphorus (also known as red phosphorus), purple phosphorus, and black phosphorus. Among them, yellow phosphorus is the most toxic, and the others are very small. If the product is impure and contains yellow phosphorus, it may cause phosphorus poisoning. Therefore, the name of the allotrope containing yellow phosphorus should be indicated in brackets after the diagnosis to distinguish it from poisoning caused by pure yellow phosphorus. 2503 According to domestic and foreign data, chronic phosphorus poisoning may cause liver and kidney damage. Because there are very few cases, liver and kidney damage is not used as a diagnostic classification standard for the time being. Although liver and kidney damage are rare, they cannot be ignored. Therefore, when conducting physical examinations on yellow phosphorus producers, attention should be paid to the overall health of the body, and health monitoring should be done if conditions permit.
B3.4 Chronic mild toxic liver disease Liver function tests such as ALT and AST are often normal. Serum bile acid determination and indocyanine green retention test (ICG) are more sensitive. Renal function tests can be performed using urine routine, urine protein quantification and urine sodium determination. Observation items can be selected based on clinical conditions. B4 Phosphorus has four allotropes, namely yellow phosphorus (also known as white phosphorus), red phosphorus (also known as red phosphorus), purple phosphorus, and black phosphorus. Among them, yellow phosphorus is the most toxic, and the others are very small. If the product is impure and contains yellow phosphorus, it may cause phosphorus poisoning. Therefore, the name of the allotrope containing yellow phosphorus should be indicated in brackets after the diagnosis to distinguish it from poisoning caused by pure yellow phosphorus. 250
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