GBZ 30-2002 Diagnostic criteria for occupational acute poisoning by amino and nitro compounds of benzene
Some standard content:
1CS13.100
National Occupational Health Standard of the People's Republic of China GBZ30—2002
Diagnostic Criteria of Occupational Acute Aromatic Amino- and Nitro-Compounds 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 the original standard GB8788-1988 is inconsistent with this standard, this standard shall prevail. In occupational activities, short-term exposure to high concentrations of amino and nitro compounds of benzene can cause acute poisoning by amino and nitro compounds of benzene. GB8788-1988 has been revised to protect the health of contacts, effectively prevent and treat acute poisoning by amino and nitro compounds of benzene, and promptly diagnose and treat poisoned patients. The revised standard is based on the principle of being connected with the general standards of occupational acute poisoning and highlighting the characteristics of acute poisoning by amino and nitro compounds of benzene. According to the progress of clinical research in the past decade at home and abroad, the diagnosis, diagnostic classification and treatment principles in the original standard have been modified and supplemented to make them 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. The responsible drafting units of this standard are: Tianjin Occupational Disease Prevention and Control Institute, Shandong Provincial Institute of Labor Health and Occupational Disease Prevention and Control. Participating drafting units: Heilongjiang Provincial Institute of Labor Health and Occupational Disease Prevention and Control, Yantai Occupational Disease Prevention and Control Institute, Zibo Occupational Disease Prevention and Control Institute.
This standard is interpreted by the Ministry of Health of the People's Republic of China. GBZ30-2002
Diagnostic criteria for occupational acute poisoning by amino and nitro compounds of benzeneOccupational acute poisoning by amino and nitro compounds of benzene is a systemic disease characterized by methemoglobinemia caused by short-term exposure to high concentrations of amino and nitro compounds of benzene in occupational activities, which may be accompanied by hemolytic anemia, liver and kidney damage.
1 Scope
This standard specifies the diagnostic criteria and treatment principles for occupational acute poisoning by amino and nitro compounds of benzeneThis standard applies to the diagnosis and treatment of acute poisoning caused by exposure to amino and nitro compounds of benzene in occupational activities. Non-occupational acute poisoning by amino and nitro compounds of benzene can be used as a reference. This standard does not apply to the diagnosis and treatment of occupational trinitrotoluene poisoning. Normative references
The clauses in the following documents become the clauses of this standard through reference in this standard. For any dated referenced document, 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 any undated referenced document, the latest version shall apply to this standard.
GB/T16180
3 Diagnostic principles
Diagnostic criteria for occupational skin diseases (general principles) Diagnostic criteria for occupational toxic liver diseases
Diagnostic criteria for occupational acute chemical poisoning blood system diseases Diagnostic criteria for occupational acute chemical poisoning nephropathy Evaluation of the degree of disability caused by work-related injuries and occupational diseases of employees Based on the occupational history of short-term exposure to high concentrations of amino and nitro compounds of benzene, the clinical manifestations mainly characterized by methemoglobinemia appear, combined with the results of on-site hygiene investigations, comprehensive analysis, and exclusion of similar diseases caused by other reasons, a diagnosis can be made.
4 Contact reaction
After contact with amino and nitro compounds of benzene, there will be mild dizziness, headache, fatigue, chest tightness, and methemoglobin will be less than 10%, which can be fully recovered in a short time.
Diagnosis and classification standards
Mild poisoning
The lips, auricles, tongue and finger (toe) nails may be accompanied by dizziness, headache, fatigue, chest tightness, methemoglobin is below 10% to 30%, and generally returns to normal within 24 hours. 5.2
2 Moderate poisoning
Skin and mucous membranes are obviously irritated, and symptoms such as palpitations, shortness of breath, loss of appetite, nausea, and vomiting may occur. The methemoglobin level is between 30% and 50%, or the methemoglobin level is less than 30% and is accompanied by any of the following: Mild hemolytic anemia, and Hernzi bodies may be slightly elevated: a)
Chemical cystitis;
Mild liver damage:
Mild kidney damage.
5.3 Severe poisoning
Skin and mucous membranes are severely irritated, the methemoglobin level is higher than 50%, and impaired consciousness may occur, or the methemoglobin level is less than 50% and is accompanied by any of the following: a) Hernzi bodies may be significantly elevated, and hemolytic anemia may ensue: b) Severe toxic liver disease;
c) Severe toxic nephropathy. www.bzxz.net
Treatment principles
Treatment principles
Leave the scene quickly, remove skin contamination, immediately inhale oxygen, and observe closely. 6.1.2
Methemoglobinemia is treated with hypertonic glucose, vitamin C, and small doses of methylene blue. Hemolytic anemia is mainly symptomatic and supportive treatment, with the focus on protecting kidney function, alkalizing urine, and using 6.1.3
appropriate amounts of adrenal glucocorticoids. In severe cases, blood transfusion should be used, and exchange transfusion or blood purification therapy should be used when necessary. Refer to GBZ75.
6.1.4 Chemical cystitis is mainly alkalizing urine, using appropriate amounts of adrenal glucocorticoids, preventing and treating secondary infections, and spasmolytics and supportive treatment can be given.
6.1.5 Damage to liver and kidney function. For treatment principles, see GBZ59 and GBZ79.6.2
2 Other treatments
After recovery, patients with mild and moderate poisoning can resume their original work. Patients with severe poisoning may be considered to be transferred from their original work depending on the recovery of the disease. If labor capacity assessment is required, it shall be handled in accordance with the relevant provisions of GB/T16180. For instructions on the correct use of this standard, see Appendix A (Informative Appendix).
Appendix A
(Informative Appendix)
Instructions on the correct use of this standard
A.1 There are many types of amino and nitro compounds of benzene. They have common physical and chemical properties and toxicity, but their acute toxicity varies greatly. Their common toxic effect is the formation of methemoglobin, which may be accompanied by hemolysis, liver and kidney damage. However, 2-methyl-4-nitroaniline does not cause methemoglobinemia, and the clinical manifestations are mainly severe liver damage. In addition to forming methemoglobin, o-toluidine, p-toluidine, chloro-o-toluidine, etc. can cause chemical cystitis, with clinical manifestations of urinary urgency, frequent urination, dysuria, and macroscopic or microscopic hematuria.
A.2 The early prominent sign of poisoning by amino and nitro compounds of benzene is urination, and other symptoms may not be obvious at this time. This feature helps the early clinical diagnosis of poisoning by such compounds. Methemoglobin is an indicator for early diagnosis of poisoning. A small amount of methemoglobin can be naturally reduced after formation, and can recover quickly after proper treatment, so blood sampling should be carried out in the early stage. When methemoglobin reaches 10%, it is the starting point for diagnosis of this disease. The classification of this standard is mainly based on the degree of methemoglobin, hemolysis, liver function damage, and kidney function damage. A.3 The hemolytic effect of amino and nitro compounds of benzene is closely related to the formation of methemoglobin, but it is not completely parallel. Nitrobenzene, o-nitrochlorobenzene, p-nitrochlorobenzene, o-nitrotoluene, etc., have a stronger effect on forming methemoglobin than on forming Hernzi bodies (denatured globin bodies). The effect of m-dinitrobenzene, m-nitroaniline, and p-nitroaniline on forming Hernzi bodies is stronger than on forming methemoglobin, and hemolysis is more likely to occur. Therefore, in addition to measuring methemoglobin, red blood cell Hernzi bodies should also be measured in poisoned patients. A.4 The diagnosis of hemolysis is based on clinical manifestations and laboratory test indicators, fever (low fever), headache, soy sauce-colored urine, yellow urine, anemia: decreased hemoglobin and red blood cells, increased reticulocytes, increased serum indirect bilirubin, positive urine bile, positive urine occult blood, and the hemolytic period may be accompanied by an increase in peripheral blood leukocytes. For the classification of hemolytic anemia, refer to GBZ80. In this disease, the appearance of Hernzi bodies is a precursor to hemolysis. In moderate poisoning, the Hernzi bodies are often higher than 20%, and in severe poisoning, the Hernzi bodies are often higher than 50%. Hernzi bodies reach a peak three to five days after poisoning. After poisoning, the Hernzi bodies in red blood cells, hemoglobin, red blood cells, reticulocytes, serum indirect bilirubin, urine bilirubin, and urine occult blood should be closely observed. A.5 Methemoglobinemia can also be caused by poisoning by drugs or other chemicals, such as chloramphenicol, nitrites, primaquine, potassium chlorate, hyponitrous acid, sulfonamides, phenacetin, benzyl alcohol, etc. It is also seen in methemoglobinemia and should be excluded in combination with relevant information. The appearance of Hernzi bodies can also be caused by other diseases, such as unstable hemoglobinopathy and 6-phosphate glucose dehydrogenase deficiency. A.6 Most of these poisons are poisoned by skin absorption, so timely and thorough removal of skin contamination is crucial and one of the important measures for treatment.
A.7 Treatment of methemoglobinemia: Contact reactions only require rest, taking sugary drinks, vitamin C, and intravenous injection of 0.5-1.0g vitamin C in 40-60ml of 50% glucose solution if necessary. For mild methemoglobinemia, 5ml of 1% methylene blue (methylene blue) or 1mg/kg can be added to 20-40ml of 25% glucose solution and slowly injected intravenously. Once is enough. Vitamin C can be given again if necessary. For moderate and severe methemoglobinemia, 5-10ml of 1% methylene blue or 1-2mg/kg can be added to 20-40ml of 25% glucose solution and slowly injected intravenously. If necessary, it can be repeated every 2-4 hours. It can be used 2-4 times as appropriate according to the results of the dynamic determination of methemoglobin. Vitamin C can be given at the same time and coenzyme A and vitamin B12 can be used. When the second dose of methylene blue is not effective, the cause should be actively sought, such as the poison not being completely removed or the burn being improperly treated, and it should not be used repeatedly blindly. 3 There is no special treatment for hemolytic anemia. The focus of treatment is to protect kidney function. When the proportion of A.8
containing Hernzi body red blood cells is greater than 50%, blood transfusion can be performed as soon as possible. 9 This standard does not include skin damage caused by amino and nitro compounds of benzene. If it occurs, refer to GBZ18 A.9
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