GB 16372-1996 Diagnostic criteria and management principles for occupational acute carbamate pesticide poisoning
Some standard content:
National Standard of the People's Republic of China
Diagnostic criteria and principles of management ofoccupational acute carbamate insecticides poisoning
Diagnostic criteria and principles of management ofoccupational acute carbamate insecticides poisoningGB 16372-1996
Acute carbamate insecticide poisoning is a systemic disease characterized by muscarinic, nicotinic and central nervous system symptoms caused by decreased cholinesterase activity in the body after short-term close contact with carbamate insecticides. 1 Subject content and scope of application
This standard specifies the diagnostic criteria and management principles of occupational acute carbamate insecticide poisoning. This standard applies to the diagnosis and management of occupational acute carbamate insecticide poisoning. 2 Diagnostic principles
According to the occupational history of short-term exposure to a large amount of carbamate pesticides, the corresponding clinical manifestations appear quickly, combined with the timely determination results of whole blood cholinesterase activity, and referring to the on-site labor hygiene survey data, a comprehensive analysis is conducted, and other causes are excluded before diagnosis can be made. 3 Diagnosis and classification standards
3.1 Mild poisoning
After short-term close contact with carbamates, mild alkaloid and central nervous system symptoms appear, such as dizziness, headache, fatigue, blurred vision, nausea, vomiting, urination, sweating, and narrowing of the sleep hole, etc. Some may be accompanied by nicotinic symptoms such as fasciculations, which generally return to normal within 24 hours. Whole blood cholinesterase activity is often below 70%. 3.2 Severe poisoning
In addition to the aggravation of the above symptoms, those who have any of the following can be diagnosed as severe poisoning: pulmonary edema,
b. coma or cerebral edema.
The activity of whole blood cholinesterase is generally below 30%. 4 Treatment principles
4.1 Leave the poisoning site quickly, take off the contaminated clothes, and wash the contaminated skin, hair and nails thoroughly with soap and warm water. 4.2 Specific antidotes:
a. Mild poisoning patients do not need specific antidotes. If necessary, oral or intramuscular atropine can be taken, but atropineization is not necessary. b. ChildrenWww.bzxZ.net
Severe poisoning patients should use atropine according to their condition and achieve atropineization as soon as possible. c.
Simple carbamate insecticide poisoning does not require revitalizing agents. 4.3 The principles of symptomatic treatment are the same as those of internal medicine.
Approved by the State Administration of Technical Supervision on May 23, 1996 274
Implemented on December 1, 1996
Labor capacity assessment
After the poisoning is cured, the patient can still engage in the original work.
Requirements for health examination
GB 16372--1996
Workers working with carbamate pesticides should undergo a physical examination before employment and once every 12 years after employment. 6.1
6.2 The physical examination includes internal medicine and neurology examinations, and the determination of cholinesterase activity in whole blood. If necessary, the content of metabolites in urine can be analyzed. 7 General occupational prohibition certificate
Organic diseases of the nervous system;
Obvious liver and kidney diseases.
A1 Principle
GB16372-1996
Appendix A
Determination of cholinesterase activity in whole blood, red blood cells and plasma (supplement)
Acetylthiocholine is hydrolyzed into thiocholine and acetate under the action of cholinesterase. Thiocholine reacts with dithiobis-nitrobenzoic acid to form a yellow compound, which is then quantified by colorimetry. The amount of thiocholine produced by hydrolysis reflects the activity of cholinesterase. A2 Instruments
a. Constant temperature water tank (37±0.5℃);
b. Centrifuge;
Spectrophotometer.
A3 Reagents
a. Thioacetyl iodide choline solution (matrix): weigh 75 mg of thioacetyl iodide choline, dissolve it in double distilled water, dilute to 10 mL, and store it in a refrigerator (4℃). Dilute 10 times with double distilled water before use. b. Dithiobis-nitrobenzoic acid solution (color developer): weigh 100 mg of dithiobis-nitrobenzoic acid, dissolve it in 50 mL of normal saline, and then add it to 50 mL of 1/15 mol phosphate buffer (pH8.0). Store it in a refrigerator. Dilute 10 times with equal volumes of normal saline and 1/15 mol phosphate buffer before use.
Physostigmine salicylate (inhibitor): Weigh 10 mg of physostigmine salicylate, dissolve it in double distilled water and dilute to 10 mL. Store in refrigerator c.
.
A4 Operation steps
A4.1 Take 10 μL of ear (or finger) blood and add it to a centrifuge tube containing 10 mL of dithiobis-nitrobenzoic acid solution, and mix gently. A4.2 Take out 4.0 mL and put it in test tube A as a tube for whole blood cholinesterase activity determination. Centrifuge the remaining solution at 3000r/min for 5 min, and transfer 4.0 mL of the supernatant to test tube B as a tube for plasma cholinesterase activity determination. Take another 4.0 mL of dithiobis-nitrobenzoic acid solution and add it to test tube C as a blank tube. A4.3 Add 1.0 mL of thioacetyl iodocholine to tubes A and BC, mix well, and record the time. A4.4 After keeping the temperature in a 37℃ constant temperature water bath for 6 minutes, add 2 drops of salicylic acid physostigmine solution to each of the above tubes and mix quickly. A4.5. Centrifuge tube A at 3000r/min for 5 minutes to precipitate the blood cells. A4.6 Use 1cm colorimetric cups to measure the absorbance of the supernatant of tube A and tube B at a wavelength of 420nm, and adjust the zero point with a blank tube. A5 Calculation
Substitute the measured absorbance of tubes A and B into formula (A1) to calculate the cholinesterase activity of whole blood and plasma. The difference between the two is the cholinesterase activity value of red blood cells.
In the formula: 1.36×104-
<six×1%×10=absorbance×7.97
1.36×10×10×2.6×-
Absorbance
(Al)
Absorption coefficient of nitrobenzoic acid ions formed in enzyme analysis. The number of nitrobenzoic acid ions is the same as the number of thiocholine produced.
The result of cholinesterase activity determination is based on 1 μm thiocholine produced per milliliter of whole blood (plasma or red blood cells) per minute as 1 unit. 27.6
A6 Precautions
GB16372-1996
Before blood collection, it is necessary to pay attention to cleaning the skin surface to prevent contamination, and accurately draw 10 μL with a hemoglobin tube treated with hepatic disorder. a.
Both the matrix and the sample need to be preheated to ensure the reaction temperature. The preheating time depends on the room temperature during the determination, generally 2 to 5 minutes. b.
The holding time of each sample must be strictly controlled within 6 minutes, that is, the time from adding the substrate to terminating the enzyme reaction must be consistent in each tube. c
Appendix B
Instructions for the correct use of the standard
(reference)
B1 This standard applies to acute poisoning of various personnel involved in the production, packaging, processing, handling and use of carbamate insecticides. Commonly used varieties in China include furadan, carbaryl, cypermethrin, chloranil, chloranil, chloranil, etc. This standard can also be used for acute carbamate insecticide poisoning in daily life. Thio (or dithio) carbamate herbicides or fungicides have no inhibitory effect on the body's cholinesterase. The diagnosis and treatment of poisoning cannot be based on this standard. B2 The clinical characteristics of acute carbamate insecticide poisoning are rapid onset, rapid recovery, relatively mild condition, and no delayed neuropathy after the poisoning is cured.
B3 The diagnostic classification of acute poisoning is mainly based on clinical manifestations, and the timely determination of blood cholinesterase activity can be used as a reference indicator. If the whole blood cholinesterase determination cannot be carried out according to Appendix A, the hydroxy iron colorimetric method can be used. B4 The diseases that need to be differentially diagnosed mainly include acute organophosphorus poisoning, eczema, acute gastroenteritis and food poisoning. It is generally not difficult to make a distinction based on the contact history, clinical characteristics, blood cholinesterase determination and dynamic observation. If necessary, the content of carbamate pesticides or their metabolites in biological materials can be determined.
B5 Currently, pesticide compounding is widely used, and the problem of mixed poisoning of carbamate and organophosphorus or other pesticides may exist at the same time. Attention should be paid to this in diagnosis and differential diagnosis.
B6 Mild poisoning is relieved quickly after breaking away from contact. Treatment can be with atropine 0.6~0.9mg orally or 0.5~1.0 mg intramuscular injection, repeat 1 to 2 times if necessary, no atropine is needed, severe poisoning should be atropine as soon as possible, but the total dose required is generally smaller than that of organophosphorus poisoning, the interval between medications can be appropriately extended, and the maintenance time is relatively short. Additional notes:
This standard is proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by the Institute of Labor Hygiene and Occupational Diseases, Chinese Academy of Preventive Medicine, with the participation of the Occupational Disease Department of Xi'an Central Hospital, Jiangsu Provincial Health and Epidemic Prevention Station, Xuzhou City Health and Epidemic Prevention Station, Zhenjiang City Health and Epidemic Prevention Station and Wuxi City Health and Epidemic Prevention Station. This standard is interpreted by the Institute of Labor Hygiene and Occupational Diseases, Chinese Academy of Preventive Medicine, the technical authority entrusted by the Ministry of Health. 277
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