GBZ 85-2002 Diagnostic criteria for occupational acute dimethylformamide poisoning
Some standard content:
ICS 13.100
National Occupational Health Standard of the People's Republic of China GBZ85-2002
Diagnostic Criteria of Occupational Acute Dimethylformamide PoisoningPublished on April 8, 2002
Implemented on June 1, 2002
Published by the 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. Dimethylformamide is an organic solvent widely used in industry. Acute poisoning may occur if a large amount of dimethylformamide is exposed in occupational activities. In order to effectively prevent and treat acute dimethylformamide poisoning and protect the health of workers, this standard is formulated. The formulation of this standard is based on the principle of being connected with the general principles of diagnosis of occupational acute chemical poisoning, highlighting the characteristics of acute dimethylformamide poisoning, and striving to be suitable for practical application. It is based on the analysis of the clinical research progress of acute dimethylformamide poisoning in China and abroad in the past 40 years, especially in the past ten years. 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: The Second Hospital of Shanxi Medical University, Yangpu District Central Hospital of Shanghai: Participating drafting units: Guangzhou Occupational Disease Prevention and Treatment Institute, Yuyao City Health and Epidemic Prevention Station of Zhejiang Province, Fuyang City Health and Epidemic Prevention Station of Zhejiang Province, Dongyang City Health and Epidemic Prevention Station of Zhejiang Province, Shanghai Occupational Disease Hospital, Zhejiang Provincial Center for Disease Control and Prevention, Heilongjiang Provincial Institute of Labor Health and Occupational Diseases.
This standard is interpreted by the Ministry of Health of the People's Republic of China. Diagnostic criteria for occupational acute dimethylformamide poisoning GBZ85-2002
Occupational acute dimethylformamide poisoning refers to a systemic disease with liver damage as the main clinical manifestation caused by short-term exposure to a large amount of dimethylformamide in occupational activities. 1 Scope
This standard specifies the diagnostic criteria and treatment principles for occupational acute dimethylformamide poisoning. This standard applies to the diagnosis and treatment of acute poisoning caused by occupational exposure to dimethylformamide. Non-occupational acute trimethylformamide poisoning can also be used as a reference. 2 Normative references
The clauses in the following documents become the clauses of this standard through reference in this standard. For all dated referenced documents, all subsequent amendments (excluding errata) or revisions are not applicable to this standard. However, the parties to the agreement based on this standard are encouraged to study whether the latest versions of these documents can be used. For all undated referenced documents, the latest versions are applicable to this standard.
GB/T16180
3 Diagnostic principles
Diagnostic standards for occupational chemical skin burnsDiagnostic standards for occupational toxic liver diseases
Identification of the degree of disability caused by work-related injuries and occupational diseases. According to the history of exposure to a large amount of dimethylformamide in a short period of time; clinical manifestations mainly with liver damage, and laboratory test results, combined with on-site labor hygiene investigations, after comprehensive analysis and exclusion of similar diseases caused by other reasons, a diagnosis can be made.
4 Contact reactions
Those with any of the following
a) After contact, there are symptoms such as dizziness, nausea, and loss of appetite, no positive signs in the abdomen, and no abnormalities in laboratory tests: b) After contact, the skin and mucous membranes have irritation symptoms such as burning pain, distending pain, and numbness. 5 Diagnosis and classification standards
5.1 Mild poisoning
Those with any of the following
a) Manifestations consistent with acute mild toxic liver disease (4.1.1 in GBZ51); b) Hemorrhagic gastroenteritis.
5.2 Moderate poisoningWww.bzxZ.net
Manifestations consistent with acute moderate toxic liver disease (4.1.2 in GBZ51). 5.3 Severe poisoning
Manifestations consistent with acute severe toxic liver disease (4.1.2 in GBZ51). Treatment principles
6.1 Treatment principles
Leave the scene, take off contaminated clothing, and immediately rinse with clean water if the skin is contaminated. 6.1.1
6.1.2 There is no specific antidote, and the main treatment is symptomatic treatment such as protecting the liver and treating hemorrhagic gastroenteritis. 6.1.3 Severe poisoning can be treated with adrenal glucocorticoids. 6.2 Other treatments
6.2.1 After mild poisoning is cured, the original work can be resumed; after moderate poisoning is cured, it is generally not advisable to engage in liver poisoning operations, and after severe poisoning is cured. It is not advisable to engage in poisoning operations. 6.2.2 If labor capacity assessment is required, it shall be handled in accordance with GB/T16180. 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 Occupational exposure to dimethylformamide can cause poisoning through respiratory tract and skin absorption. Due to the different routes of entry of the poison and the amount of exposure, there may be a latent period of 6-24 hours. Therefore, those who have contact reactions after exposure to a large dose in a short period of time should be observed for 24 hours.
A.2 The clinical characteristics of occupational dimethylformamide poisoning are mainly damage to the digestive system, especially the liver. There may be hemorrhagic gastroenteritis, skin and mucosal irritation symptoms, and direct contact may cause dermatitis or skin burns. A.3 The clinical manifestations of hemorrhagic gastroenteritis mentioned in this standard are nausea, vomiting, abdominal distension, abdominal pain, etc. in mild cases, among which abdominal pain is particularly prominent. Severe cases are manifested as severe burning pain or colic in the abdomen, mostly in the upper abdomen and around the navel, and can also spread throughout the abdomen. There is tenderness in the upper abdomen and around the navel, without rebound pain and muscle tension. Laboratory tests show that the fecal occult blood test is positive, and fiber endoscopy can show congestion, edema, erosion of the gastric and duodenal mucosa, accompanied by bleeding spots. Hemorrhagic gastroenteritis is a more prominent manifestation of dimethylformamide poisoning, but before making a diagnosis based on this, it is necessary to pay attention to distinguishing it from other digestive tract diseases.
A.4 A small number of patients may experience proteinuria, increased blood urea nitrogen, and creatinine, transient changes in blood pressure, and electrocardiograms show: arrhythmia, I-II degree atrioventricular block, and ST-T changes, which last for a short time and have a good prognosis. Therefore, it is not used as a diagnostic indicator, but these changes should be noted during clinical diagnosis and treatment. A.5 For the convenience of use, the relevant diagnostic classification and classification standards in GBZ51 are excerpted as follows: 4.1.1 Acute mild toxic liver disease: After absorbing a high concentration of liver poison in a short period of time, two of the following manifestations appear: a. There are symptoms such as fatigue, loss of appetite, nausea, and pain in the liver area; b. The liver is enlarged, soft, and tender, and may be accompanied by mild jaundice: c. Routine liver function tests are abnormal in acute toxic liver disease. 4.1.2 Acute moderate toxic liver disease: patients with obvious fatigue, mental fatigue, anorexia, aversion to oil, nausea, abdominal distension, pain in the liver area, etc., liver enlargement, obvious tenderness, abnormal routine liver function test of acute toxic liver disease, and accompanied by the following manifestations. a. Moderate jaundice; b. Splenomegaly; c. Course of disease for more than four weeks. 4.1.3 Acute severe toxic liver disease: patients with one of the following conditions on the basis of the above clinical manifestations. a. Hepatic encephalopathy; b. Obvious jaundice; c. Ascites; d. Hepatorenal syndrome; e. Prolonged prothrombin time, more than double the normal value, accompanied by bleeding tendency.
Appendix C Clinical application of liver function tests
Conventional liver function tests for acute toxic liver disease: refers to serum alanine aminotransferase (ALT) and serum bilirubin quantitative tests; serum bile acid determination, serum aspartate aminotransferase (AST), serum prealbumin (PA) or serum glutamyl transpeptidase (Y-GT) can be selected when necessary. Appendix A3 Jaundice grading
Mild jaundice refers to serum bilirubin above normal but below 51.3mmol/L: moderate jaundice refers to serum total bilirubin between 51.3-85.5mmol/L, and obvious jaundice refers to serum total bilirubin above 85.5mmol/L. A.6 The metabolite of dimethylformamide in urine, methylformamide (NMF), is linearly related to the concentration of dimethylformamide in the air and has specificity. It can be used as a biological monitoring exposure indicator. A.7 When the skin and mucous membranes are contaminated, they should be rinsed with clean water, not with alkaline liquid, to avoid the production of dimethylamine. Skin burns should be treated according to GBZ51.
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