This standard specifies the diagnostic criteria and treatment principles for occupational acute carbonyl nickel poisoning. This standard applies to the diagnosis and treatment of occupational acute carbonyl nickel poisoning. The diagnosis of non-occupational acute carbonyl nickel poisoning can also refer to this standard. GBZ 28-2002 Occupational acute carbonyl nickel poisoning diagnostic criteria GBZ28-2002 standard download decompression password: www.bzxz.net

ICS13.100
National Occupational Health Standard of the People's Republic of China GBZ 28—2002
Diagnostic Criteria of Occupational Acute Nickel Carbonyl 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 there is any inconsistency between the original standard GB8786-1988 and this standard, this standard shall prevail. Carbonyl nickel is commonly used in metal smelting, purification, catalysis and other industries. In occupational activities involving contact with carbonyl nickel, acute poisoning can often occur in the contact. In order to protect the health of the contact and prevent and treat carbonyl nickel poisoning, the standard GB8786-1988 has been revised based on the progress of clinical research in recent years.
The revised standard is consistent with GBZ73 standard, and highlights the principle of acute carbonyl nickel poisoning itself. It is supplemented and modified on the basis of the original diagnostic standard. It makes the diagnostic classification clearer, more comprehensive and easier to apply. 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 revised version of this standard was drafted by Suzhou University Medical College and Dalian Institute of Labor Hygiene, and Nuclear Industry 857 Factory, Nuclear Industry 8th Institute and Shanghai Sangang Hospital participated in the drafting. This standard is interpreted by the Ministry of Health of the People's Republic of China 2
Diagnostic standard for occupational acute carbonyl nickel poisoning GBZ28-2002
Occupational acute carbonyl nickel poisoning is a systemic disease with acute respiratory damage as the main manifestation caused by exposure to a large amount of carbonyl nickel in a short period of time in occupational activities. 1 Scope
This standard specifies the diagnostic criteria and treatment principles for occupational acute carbonyl nickel poisoning. This standard applies to the diagnosis and treatment of occupational acute carbonyl nickel poisoning. The diagnosis of non-occupational acute carbonyl nickel poisoning 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 references, all subsequent amendments (excluding errata) or revisions are not applicable to this standard. However, parties that reach an agreement based on this standard are encouraged to study whether the latest versions of these documents can be used. For all undated references, the latest versions are applicable to this standard. bzxZ.net
GB/T16180
3 Diagnostic principles
Diagnostic standards for occupational acute chemical poisoning respiratory diseases 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 a large amount of carbonyl nickel, clinical manifestations of respiratory system damage and chest X-ray manifestations: combined with blood gas analysis, refer to the on-site labor hygiene survey, comprehensive analysis, and exclusion of similar diseases caused by other causes, diagnosis can be made.
4 Irritation reaction
There are transient symptoms of upper respiratory tract irritation, no positive signs in the lungs, and no abnormalities in chest X-rays. 5 Diagnosis and classification standards
5.1 Mild poisoning
Symptoms include dizziness, headache, nausea, drowsiness, chest tightness, dry throat, nausea, and loss of appetite: Physical examination shows mild congestion of the conjunctiva and pharynx, and scattered dry and wet rales in both lungs; chest X-ray examination is normal or shows increased, thickened, and blurred edges in both lungs. The above manifestations are consistent with acute bronchitis or peribronchitis. 5.2 Moderate poisoning
Those with one of the following conditions:
a) Cough, sputum, shortness of breath, chest tightness, blood in sputum or mild hemorrhage; obvious dry and wet rales in both lungs: Chest X-ray examination shows enhanced texture and blurred edges in both lungs, and dot-like or patchy shadows in the middle and lower lung fields. The above manifestations are consistent with acute bronchopneumonia;
b) Cough, sputum, and shortness of breath are more severe; breath sounds are reduced; chest X-ray examination shows blurred and enlarged hilar shadows, scattered small dot-like shadows and reticular shadows in both lungs, and reduced lung field transparency. The above manifestations are consistent with acute interstitial pulmonary edema. 3
Blood gas analysis often shows mild to moderate hypoxemia. 5.3 Severe poisoning
Those with one of the following conditions:
a) Coughing up a large amount of white or pink foamy sputum, obvious dyspnea, purple, diffuse moist rales in both lungs; chest X-ray examination shows that both lung fields have flakes or cloud-like shadows of varying sizes and blurred edges, which can sometimes merge into large flakes or butterfly-shaped distribution. The above manifestations are consistent with alveolar pulmonary edema; b) Acute respiratory distress syndrome.
Blood gas analysis often shows severe hypoxemia.
6 Treatment principles
6.1 Treatment principles
6.1.1 Immediately leave the poisoning site and take off the contaminated clothing. Wash the contaminated skin and hair, rest in bed, and keep quiet. Closely observe and give symptomatic treatment. 6.1.2 Correct hypoxia by giving oxygen inhalation and keeping the airway open. 6.1.3 To prevent and treat pulmonary edema, glucocorticoids should be used early, in sufficient quantities, and for a short period of time, and the amount of fluid input should be controlled. Defoaming agents (dimethyl silicone oil aerosol) can be used.
6.1.4 Prevent infection, prevent and treat complications, and maintain electrolyte balance. 6.1.5 For severe poisoning, sodium diethyldithiocarbamate (dithiocarb) can be taken orally, 0.5g each time, 4 times a day, and an equal amount of sodium bicarbonate can be taken at the same time. The number of days to be used depends on the condition, and the medication can generally be taken continuously for 3-7 days. Nebulization inhalation can also be used.
6.2 Other treatments
Patients with mild and moderate poisoning can resume their original work after recovery. Patients with severe poisoning who still have obvious symptoms after treatment should be arranged to rest as appropriate and transferred away from carbonyl nickel work. If labor capacity assessment is required, it shall be handled in accordance with GB/T16180. 7 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 This standard applies to acute carbonyl nickel poisoning. Acute poisoning of other carbonyl metals such as carbonyl iron and carbonyl cobalt can be used as a reference.
A.2 The diagnostic classification of this standard is based on the degree of damage to the respiratory system. The irritation reaction is a transient reaction after contact with carbonyl nickel, which has not yet reached the degree of poisoning. In order to closely observe the development of the disease and facilitate timely treatment, it is included in the classification standard, but it does not belong to acute poisoning.
A.3 Close clinical observation is required for workers exposed to carbonyl nickel when suspected of acute poisoning. The observation time is not less than 48 hours.
A.4 Acute carbonyl nickel poisoning causes pulmonary edema, leading to hypoxia. The determination of PaO2 in blood gas analysis can understand the degree of hypoxia in the body, but a comprehensive analysis of clinical and dynamic measurement data is required to correctly judge the condition. A.5 Severe acute poisoning often causes changes in electrocardiogram, liver and kidney function due to hypoxia. These changes can often recover with the correction of hypoxia, so they are not included in the diagnosis terms. A.6 The diagnosis of acute respiratory distress syndrome (ARDS) refers to GBZ73. A.7 In order to grasp the overall condition of poisoning, in addition to chest X-ray examination, patients with severe poisoning can choose to check electrocardiogram, liver and kidney function according to the condition. After the acute symptoms of the respiratory system are relieved, pulmonary ventilation function measurement needs to be performed according to the patient's clinical condition. A.8 Early application of sodium diethyldithiocarbamate has a preventive effect on toxic pulmonary edema caused by carbonyl nickel.
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