GB 16385-1996 Diagnostic criteria and treatment principles for occupational acute thallium poisoning
Some standard content:
GB16385--1996
Acute thallium poisoning may occur in occupational activities involving exposure to thallium. This standard is formulated to protect the health of those exposed to thallium and facilitate the prevention and treatment of thallium poisoning.
Appendix A of this standard is a reminder appendix. This standard is proposed by the Ministry of Health of the People's Republic of China. The drafting unit of this standard is Jiangxi Provincial Institute of Occupational Health and Occupational Disease Prevention and Control. This standard is interpreted by the Institute of Occupational Health and Occupational Diseases of the Chinese Academy of Preventive Medicine, the technical unit entrusted by the Ministry of Health. 334
National Standard of the People's Republic of China
Diagnostic criteria and principles of managementof occupational acute thallium poisoningGB16385-1996
Occupational acute thallium poisoning is a systemic disease with nervous system damage as the main manifestation caused by inhaling a large amount of thallium-containing smoke, vapor or soluble thallium salts in a short period of time during occupational activities and absorbing them through the respiratory tract, skin and digestive tract. 1 Scope
This standard specifies the diagnosis and treatment of occupational acute poisoning. This standard applies to the diagnosis and treatment of occupational acute thallium poisoning, and can also be used as a reference for non-occupational acute thallium poisoning. 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 version of the following standards. GB4865-85 Occupational chronic allyl chloride poisoning diagnosis criteria and treatment principles 3 Diagnostic principles
Based on the exact occupational exposure history, combined with a comprehensive analysis of clinical symptoms, signs and on-site hygiene survey data, and excluding similar diseases caused by other causes, the diagnosis can be made. Increased urine thallium content can be used as an exposure indicator. For instructions on the correct use of standards, see Appendix A (Suggested Appendix). 4 Diagnosis and classification standards
4.1 Observation subjects
Symptoms such as dizziness, headache, fatigue, nausea, vomiting, abdominal pain, burning sensation in the throat, etc. will appear after exposure, and the urine content will increase. 4.2 Mild poisoning
In addition to symptoms of dizziness, headache, fatigue, loss of appetite, and heaviness of lower limbs, any of the following is also present: a) Numbness of the distal extremities, especially the lower extremities, hyperalgesia, decreased pain and tactile sensation in a glove or sock distribution, or decreased Achilles tendon reflex; b) Neuro-electromyography shows neurogenic damage. For the inspection methods and judgment criteria, see Appendix A (Supplement) of GB4865-85. 4.3 Severe poisoning
The above symptoms are aggravated and have one of the following manifestations: a) toxic encephalopathy or toxic psychosis; b) obvious muscle atrophy of the distal limbs and affecting motor function, or multiple cranial nerve damage; c) electromyography shows neurogenic damage and more spontaneous denervation potentials; d) accompanied by obvious heart, liver or kidney damage.
5 Treatment principles
5.1 Immediately leave the scene, and those with contaminated skin or eyes should immediately rinse thoroughly with clean water. 5.2 The subject needs to rest in bed, be closely observed for at least 48 hours, and be given necessary inspections and treatments. Approved by the State Administration of Technical Supervision on May 23, 1996 and implemented on December 1, 1996
5.3 Symptomatic treatment and supportive therapy
GB16385--1996
Strengthen nutrition and use B vitamins. Adrenal glucocorticoids should be used for severe poisoning. For oral poisoning, Prussian blue should be used after gastric lavage. The general dosage is 250 mg/(kg·d), divided into four oral doses, each time dissolved in 50 mL of 15% mannitol. Catharsis and diuresis can also be used to promote the excretion of thallium. For severe poisoning, hemodialysis or blood flow treatment can be considered. 6 Labor capacity assessment
6.1 After a short rest after treatment of mild poisoning, work can be arranged after health recovery. 6.2 Severe poisoning should be transferred from the original job, and rest or work arrangement should be decided according to the recovery of the disease. 7 Health examination requirements
7.1 Workers who are exposed to thallium compounds should undergo a pre-employment physical examination, including internal medicine, neurology, ophthalmology, liver and kidney function examinations. 7.2 Workers engaged in armor work should undergo a physical examination once a year. In addition to the same examination items as the pre-employment physical examination, the content of armor in urine can also be measured. Electroencephalogram, electromyogram, and nerve conduction velocity examinations should be performed when necessary. 8 Occupational poisoning
a) Organic diseases of the nervous system;
b) Mental illness and obvious neurosis,
c) Obvious liver and kidney diseases.
A1 Scope
GB16385-1996
Appendix AWww.bzxZ.net
(Suggested Appendix)
Instructions for correct use of the standard
This standard applies to acute poisoning caused by contact with various armor compounds. Non-occupational acute armor poisoning can also be implemented as a reference, but due to different poisoning routes, such as oral poisoning, the first symptoms are prominent digestive tract symptoms. A2 Diagnostic principles
Thallium is highly toxic, but thallium poisoning has a latent period from the intake of the poison to the onset of symptoms. The clinical manifestations of acute poisoning, especially in the early stage, have no specific symptoms and signs. Therefore, the diagnosis must be based on the exact occupational exposure history and the working environment conditions that can cause poisoning, combined with clinical manifestations and special laboratory tests for comprehensive diagnosis, and pay attention to differentiation from corresponding diseases. A3 Diagnosis and grading standards
Acute thallium poisoning mainly manifests clinically in the digestive tract, nervous system, and hair loss. Symptoms of peripheral nerve damage usually appear 2 to 5 days after poisoning. The diagnosis of mild poisoning is mainly based on peripheral nervous system damage. Severe poisoning is caused by aggravated peripheral nervous system damage or central nervous system and multiple cranial nerve damage. Hair loss is one of the specific signs of poisoning. It usually appears 2 to 3 weeks after poisoning. Hair falls off in bundles. In severe cases, it can fall off completely within a month: beard, armpit hair, pubic hair and eyebrows can also fall off or be easily pulled out, but the inner 1/3 of eyebrows is often not affected. There are also poisoned patients who do not suffer from hair loss. This standard proposes urine thallium testing, which can be used as an exposure indicator and as a reference for diagnosis. Other indicators, neuro-electromyography examination, indicate neurogenic damage. A4 Treatment
Mainly symptomatic supportive treatment, a large amount of B vitamins, to protect organs such as the liver, kidneys, and heart. Regarding the application of complexing agents, calcium sodium edetate, sodium dithiopropane sulfonate, cysteamine, etc. have been tried, but they have no definite detoxification effect, so they are not recommended. Oral Prussian blue can be given.
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