GB 16852.2-1997 Diagnosis of occupational acute chemical poisoning Part 2: Diagnostic rules for occupational acute latent chemical poisoning
Some standard content:
GB16852.2-1997
In various occupational activities, people may be exposed to some high-concentration and highly toxic chemicals in a short period of time, resulting in acute poisoning. Some of these chemicals are known species, while others are still unclear pathogenic species after the poisoning has occurred. Some species have been included in the list of occupational diseases revised in Document No. 60 of the Ministry of Health and Welfare (87) “Regulations on the Scope of Occupational Diseases and the Treatment of Occupational Disease Patients”, while others have not yet been included; some have independent diagnostic standards, while others have not yet developed independent diagnostic standards. However, all acute poisoning diseases have common pathogenesis patterns, and it is possible and necessary to formulate common rules to be followed when diagnosing acute poisoning. The various rules stipulated in this series of standards involve the diagnosis of occupational acute chemical poisoning. These rules are used to ensure the unification of the diagnostic system of occupational acute chemical poisoning. Regardless of whether the cause is known or hidden, and regardless of which target organ is damaged after poisoning, the diagnosis can be made according to the rules stipulated in this standard. "Diagnosis of Occupational Acute Chemical Poisoning" includes the following parts. The scope of each part will be explained in the foreword and introduction of each part: Part 1 General principles for diagnosis of occupational acute chemical poisoning; Part 2
Part 3wwW.bzxz.Net
Part 4
Part 5
Part 6
Part 7
Part 8
Part 9
Diagnosis rules for occupational acute latent chemical poisoning; Diagnosis of occupational acute toxic multiple organ failure, diagnosis of occupational acute chemical-induced sudden death; diagnosis of occupational acute toxic nervous system diseases; diagnosis of occupational acute toxic respiratory system diseases, diagnosis of occupational acute toxic liver diseases;
Diagnosis of occupational acute toxic kidney diseases; diagnosis of occupational acute toxic heart diseases; Part 10 Diagnosis of occupational acute toxic blood system diseases; This standard specifies the rules for diagnosis of occupational acute latent chemical poisoning. Appendix A and Appendix B of this standard are the appendices of the standard. Appendix C of this standard is the appendix of the reminder. This standard is proposed by the Ministry of Health of the People's Republic of China. The drafting units of this standard are: Shanghai Sixth People's Hospital, Jinan Occupational Disease Prevention and Treatment Institute, Institute of Labor Hygiene and Occupational Diseases, Chinese Academy of Preventive Medicine, Shanghai Institute of Labor Hygiene and Occupational Disease Prevention and Treatment, Shandong Provincial Hospital, Shenyang Institute of Labor Hygiene and Occupational Diseases, Shanghai Changning District Health Bureau.
This standard is entrusted to the Institute of Labor Hygiene and Occupational Diseases, Chinese Academy of Preventive Medicine, which is the technical authority, for interpretation. 384
National Standard of the People's Republic of China
Diagnosis of occupational acute chemical poisoning
Part 2: Diagnostic guideline of occupational acute obscure chemical poisoning
GB16852.2—1997
Occupational acute obscure chemical poisoning refers to poisoning caused by workers absorbing large doses of occupational chemicals in a short period of time without knowing it during their occupational activities.
1 Scope
This standard specifies the diagnostic rules for occupational acute obscure chemical poisoning. This standard applies to acute poisoning caused by unknowing and unaware exposure to chemicals in occupational activities. This standard can also be used as a reference for the diagnosis of acute poisoning caused by unknowingly absorbing chemicals in non-occupational activities. 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 versions of the following standards. GB16852.1-1997 Diagnosis of occupational acute chemical poisoning Part 1: General principles for diagnosis of occupational acute chemical poisoning 3 Diagnostic principles
According to the clues of acute poisoning suggested by clinical, laboratory, and field investigation, further obtain sufficient etiological evidence, combine the corresponding clinical manifestations and (or) necessary field data and other comprehensive analysis, exclude similar diseases, and then diagnose occupational acute chemical poisoning. 4 Diagnostic points
4.1 Determine the cause
Patients with latent poisoning cannot provide a history of exposure to poisons when they visit the doctor. Determine the cause First, obtain clues that may be poisoning from the medical history, physical signs, laboratory tests or (and) field investigation. Get inspiration from clues, and then conduct in-depth observation, inspection, investigation, biological material testing, etc. to clarify the cause of poisoning, including
a) the type of virulence agent,
b) the cause of poisoning#
c) the time of absorbing the poison,
d) the route of invasion;
e) estimated absorbed dose, etc.
These are the primary basis for confirming chemical poisoning. Approved by the State Bureau of Technical Supervision on June 10, 1997 and implemented on January 1, 1998
4.2 Relatively complete clinical data
4.3 Comprehensive analysis
GB16852.2—1997
After comprehensive analysis, including differential diagnosis, it is concluded that the cause and disease have a definite causal relationship. After the cause of latent poisoning is determined, its diagnostic method, classification standard, etc. are exactly the same as those of general acute chemical poisoning, and should be treated according to GB16852.1.
4.4 Toxicological test
If there is little toxicological data on the suspected toxicogen, making it difficult to make a diagnosis, necessary toxicological experiments should be conducted to clarify the toxicity and toxic effects of the poison, as one of the comprehensive diagnostic analysis data. 5 Treatment principles
Determine the treatment plan based on the type of toxicogen, clinical characteristics, severity, etc. (see GB16852.1). When the diagnosis of poisoning is not clear, necessary examinations, rescue and various treatment measures should be given according to the specific situation of the patient. 6 Work capacity assessment
Treat according to the specific situation (see GB16852.1). 386
GB16852.2—1997
Appendix A
(Standard Appendix)
Diagnosis and differential diagnosis of occupational acute cryptogenic and other cryptogenic poisonings Due to the special poisoning mode of acute cryptogenic poisoning, a clear diagnosis must have a definite etiological basis. The specific methods and steps are as follows: A1 Obtaining clues of possible acute chemical poisoning is the first and key step to make a clear diagnosis. A1.1 Obtain clues from medical history
a) In the occupational history, the operator is not aware of the contact with the capsule, or there are other conditions that may cause poisoning; b) In the same environment, multiple people have similar syndromes at the same time or in a short period of time, which cannot be explained by common infectious diseases or local diseases; c) The onset or (and) the progression of the disease do not conform to the law of the suspected disease; d) There is a history of epilepsy, psoriasis, mental illness and other stubborn diseases in the past history, and there has been a history of receiving folk remedies, folk remedies or informal doctors: e) There is a history of drinking with tin (lead) pots in the life history, or a history of special hobbies such as drug abuse, solvent absorption, etc.; f) The patient's mental state, emotions, interpersonal relationships, etc., from which to consider whether there is a possibility of murder or suicide by poison. A1.2 Obtain clues from physical signs
Perform a detailed physical examination to find clues that may indicate acute poisoning, such as: a) Special smell of exhaled breath: garlic smell of organophosphorus pesticides, rotten egg smell of hydrogen sulfide, aromatic smell of organic solvents, alcohol smell of methanol or ethanol, etc.
6) Sweating degree: heavy sweating is seen in acute poisoning such as sodium pentanophenol, dinitrophenol, and organophosphorus pesticides; excessive sweating is seen in poisoning by pyrethroids and carbamate pesticides; no sweating is seen in poisoning by atropine; c) Hair loss: seen in poisoning by thallium, chloroprene, etc.; d) Mucous membrane and skin color: purple-brown, and systemic hypoxia symptoms If the condition is mild, methemoglobinemia should be considered; cherry-red lips and cheeks are seen in some acute carbon monoxide poisoning.
e) Pupil: constriction is seen in acute poisoning of organophosphorus pesticides, carbamate pesticides, and morphine-type sleeping pills; dilation is seen in atropine and methanol poisoning; unequal sizes and morphological changes on both sides are seen in acute toxic encephalopathy; f) Oral ulcers and gingival erosions: seen in acute mercury poisoning and oral corrosive poisons; g) Pain in the limbs, glove-sock type paresthesia and pain in the limbs, sensitive sensation to touch of the soles of the feet, and may be accompanied by movement disorders, which are common in multiple peripheral neuropathy caused by acute poisoning.
A1.3 Obtain clues from laboratory tests
When the results obtained from the laboratory or other auxiliary tests cannot be explained by the initial diagnosis of the disease, the possibility of acute poisoning should be considered and clues should be obtained from it.
A1.4 Obtain clues that may be poisoning from the on-site investigation. A2 Obtain etiological basis
A2.1 Based on the above clues that may be acute poisoning, explore the cause of the disease, that is, the type of virus: a) Determine the type of poison and its content from the suspected pathogenic food, containers, water sources, local medicines and other materials in the on-site ambient air; b) Determine the type of poison and its content from the patient's biological materials: c) Determine the type of poison and its content from other materials and samples according to specific circumstances. A2.2 Through investigation, obtain the time, cause, invasion route and possible absorbed dose of the patient's absorption of the poison. A2.3 Analyze the above situation, judge that the patient has the basis for absorbing the poison, and obtain clear etiological information. A3 Establish diagnosis
A3.1 Obtain clear etiological basis from A2. A3.2 Complete clinical data, especially the nature and severity of damage to the main target system (organ), and fully grasp the situation of the lesion. A3.3 Comprehensive analysis to draw the conclusion that the cause (poison) and the disease are indeed causally related. For the analysis method, please refer to GB16852.1. 387
GB16852.2—1997
A3.4 Make a good differential diagnosis to prevent "false diagnosis" and "abuse of diagnosis". Appendix B
(Suggested Appendix)
Common causes of hidden poisoning B1 Occupational factors
Acute occupational poisoning belongs to the category of hidden poisoning in the following cases. B1.1 The operator is unaware of the contact with toxic substances in production and cannot provide information on the contact with toxic substances after poisoning occurs. For example, the glue used in production contains organic solvents, but the workers are unaware of it and do not pay attention to protection during work and are poisoned. The benzene content in the viscose of leather shoes is as high as 90%, but the provider falsely claims to be toluene, resulting in severe aplastic anemia caused by benzene poisoning in a short period of time. B1.2 The contact substance was originally thought to be non-existent, but a chemical reaction occurred for some reason and produced poisons, such as ferrosilicon ore deliquescing with water to produce phosphine, and arsenic-containing ore producing arsenic hydrogen when it meets acid, etc. After poisoning, the exact type of contact poison cannot be provided. B1.3 Poisoning caused indirectly by occupational contact, such as others wearing work clothes contaminated by poisons, cleaning utensils and protective equipment contaminated by poisons, etc., and not thoroughly cleaning the poisons after work, which contaminates family members and causes acute poisoning. B1.4 Because scientific research and industrial and agricultural production do not pay attention to environmental protection, the air, water sources, and soil are polluted by occupational poisons, which is one of the main reasons for the hidden poisoning of the majority of residents. B2 Food pollution
B2.1 Poisons directly contaminate food, and the eater is poisoned without knowing it, such as pesticides contaminating vegetables and fruits, and seeds soaked in pesticides are processed as food, etc.
B2.2 Poisoning caused by eating poultry, livestock or fish that have been contaminated by poisons, such as Japanese water retention disease. B2.3 Using containers containing poisonous substances to hold food and drinks, such as using inferior tin pots (high in lead content) to hold wine, which causes lead colic caused by lead poisoning. B2.4 Using poisonous substances as condiments or fermentation agents, such as using sodium nitrite as salt, sodium fluorosilicate as baking soda, and ethylene glycol as a beverage.
B2.5 Eating inappropriate items, such as the "Hukou disease" in Jiangxi, which is caused by eating cotton oil without proper heating, and eating "fireworks salt" causing thallium poisoning.
B3 Water source pollution
B4 Air pollution
Abuse of poisons
Using poisonous substances on clothes, bedding, etc. as insecticides and disinfectants, and absorbing them through the skin to cause poisoning. Using folk remedies, folk prescriptions, or other drugs to cause poisoning, such as using folk medicines containing lead to treat epilepsy, and using folk medicines containing arsenic and mercury to treat psoriasis. B6
Iatrogenic factors
Such as mistakenly mixing milk with Sanisol, using sodium nitrite as a saline enema, etc. B8 Murder
Murder with poison, the victim is poisoned without knowing it. Appendix C
(Suggested Appendix)
Instructions for the correct use of the standard
C1 Acute latent poisoning--Once the cause is confirmed to be chemical poisoning, the diagnosis should be handled according to GB16852.1, and the diagnostic standards for target systems (organs) of occupational acute poisoning can also be referred to. C2 Finding clues that the patient may have acute chemical poisoning is a key breakthrough point in diagnosis. This standard includes the diagnosis methods, steps and sources of possible clues of poisoning for acute latent poisoning as Appendix A, and the common causes of acute latent poisoning as Appendix B for reference and application.
C3 Epidemiological survey
In the case of mass disease, epidemiological survey can provide scientific data to clarify the cause of disease, the law of disease occurrence and development, factors affecting the condition and prognosis, etc. In some cases, it is one of the important methods to solve hidden poisoning and can be applied according to the situation. C4 Pathological examination of the household
For those who have not been diagnosed with suspected acute chemical poisoning before death, or those whose acute chemical poisoning diagnosis before death is basically clear but there are still some important problems that cannot be explained, household examination should also be done. The household examination can systematically observe the pathological changes of various organs, make pathological diagnosis and judge the cause of death.
However, since there are no specific pathological changes in household examinations of acute poisoning caused by many poisons, it is still necessary to use multiple methods to clarify the cause of disease.
When conducting household examinations, the content of pathogenic substances in various major organs should be measured as much as possible. C5 Prevent "diagnosis" and "abuse of diagnosis" and expose "false diagnosis" When highly vigilant about the possibility of acute chemical poisoning, attention should be paid to preventing "false diagnosis" and "abuse of diagnosis". "False diagnosis" refers to the diagnosis of chemical poisoning when there is a history of exposure to toxic substances but no poisoning has occurred. "Overdiagnosis" refers to the diagnosis of chemical poisoning when the history of exposure to toxic substances is unclear and there is no poisoning. Both of these situations are misdiagnoses, and more attention should be paid to prevent them when multiple people are poisoned. "False diagnosis" refers to the diagnosis of chemical poisoning given by the doctor knowing that the person is not poisoned in order to achieve a certain purpose. This diagnosis is forged, so it is called false diagnosis. This is a serious violation of medical ethics and laws, and must be exposed once discovered. Therefore, obtaining clues that may be acute chemical poisoning is only the first step, only clues, not conclusions. Further work must be done to collect more materials before a diagnosis can be made. C6 Asking a good medical history and doing a good physical examination are even more important in the diagnosis of latent poisoning, and must be carried out conscientiously. In the entire diagnostic process, accurate and complete materials are the only basis for making a diagnosis. The materials must be accurate, and inaccurate materials will lead to incorrect analysis and judgment. The materials must also be complete, and avoid relying on isolated materials as the only basis for diagnosis, even if they are specific. C7 developed diagnostic criteria for latent poisoning, which not only helps clinical diagnosis and treatment, but also can attract widespread attention and the attention of relevant departments, so as to take comprehensive measures and do a good job in prevention.4 As scientific research, industrial and agricultural production fail to pay attention to environmental protection, the air, water sources and soil are polluted by occupational poisons, which is one of the main reasons for hidden poisoning among the general public. B2 Food pollution
B2.1 Poisons directly contaminate food, and consumers are poisoned without knowing it, such as pesticides contaminating vegetables and fruits, and seeds soaked in pesticides are processed as food, etc.
B2.2 Poisoning caused by eating poultry, livestock or fish that have been contaminated by poisons, such as Japanese water retention disease. B2.3 Using containers containing poisons to hold food and drinks, such as using inferior tin pots (high in lead content) to hold wine, causing lead colic caused by lead poisoning, etc. B2.4 Using poisons as condiments, fermentation agents, etc., such as using sodium nitrite as salt, sodium fluorosilicate as baking soda, and ethylene glycol as a beverage, etc.
B2.5 Eating inappropriate items, such as the "Hukou disease" in Jiangxi, which is caused by eating cotton oil without proper heating, and eating "fireworks salt" causing thallium poisoning.
B3 Water source pollution
B4 Air pollution
Abuse of poisons
Using poisons on clothes, bedding, etc. as insecticides and disinfectants, and absorbing poison through the skin. Using folk remedies, folk prescriptions or other drugs to cause poisoning, such as using folk medicines containing lead to treat epilepsy, and using folk medicines containing arsenic and mercury to treat psoriasis. B6
Iatrogenic factors
For example, mistakenly using Sanisol to mix milk, using sodium nitrite as saline for enema, etc. B8 Murder
Murder with poisons, the victim is poisoned unknowingly. Appendix C
(Suggested Appendix)
Instructions for the correct use of the standard
C1 Acute latent poisoning--Once the cause is confirmed to be chemical poisoning, the diagnosis should be handled in accordance with GB16852.1, and the diagnostic standards for target systems (organs) of occupational acute poisoning can also be referred to. C2 Finding clues that the patient has acute chemical poisoning is a key breakthrough point in diagnosis. This standard includes the diagnosis methods, steps and sources of possible clues of acute latent poisoning as Appendix A, and the common causes of acute latent poisoning as Appendix B for reference and application.
C3 Epidemiological survey
In the case of mass disease, epidemiological surveys can provide scientific data for clarifying the cause, the law of disease occurrence and development, and the factors affecting the condition and prognosis. In some cases, it is one of the important methods to solve latent poisoning and can be applied according to the situation. C4 Pathological examination of the body
For suspected acute chemical poisoning patients who could not be clearly diagnosed before death, or for patients whose acute chemical poisoning diagnosis was basically clear before death but some important issues could not be explained, a physical examination should also be performed. Physical examination can systematically observe the pathological changes of various organs, make pathological diagnosis and determine the cause of death.
However, since many acute poisonings caused by poisons do not show specific pathological changes in physical examination, it is still necessary to use multiple methods to clarify the cause of the disease, which is still a necessary basis for diagnosis.
During physical examination, the content of pathogenic substances in major organs should be measured as much as possible. C5 Prevent "false diagnosis" and "abuse diagnosis", and expose "false diagnosis" When being highly alert to the possibility of acute chemical poisoning, attention should be paid to preventing "false diagnosis" and "abuse diagnosis". "False diagnosis" refers to the diagnosis of chemical poisoning when there is a history of exposure to poisons but no poisoning has occurred. "Abuse diagnosis" refers to the diagnosis of chemical poisoning when the history of exposure to poisons is not clear and there is no poisoning. Both of these situations are misdiagnosis, and more attention should be paid to prevent them when multiple people are poisoned. "False diagnosis" means that the doctor gives a diagnosis of chemical poisoning to achieve a certain purpose even though he knows that the person is not poisoned. This diagnosis is forged, so it is called a false diagnosis. This is a serious violation of medical ethics and the law, and it must be exposed once discovered. Therefore, obtaining clues that may be acute chemical poisoning is only the first step, just clues, not conclusions. Further work must be done to collect more materials before a diagnosis can be made. C6 Asking a good medical history and doing a good physical examination are even more important in the diagnosis of latent poisoning, and must be carried out conscientiously. During the entire diagnostic process, accurate and complete materials are the only basis for making a diagnosis. The materials must be accurate, and inaccurate materials will lead to erroneous analysis and judgment. The materials must also be complete, and avoid relying on isolated materials as the only basis for diagnosis, even if they are specific. C7 The development of diagnostic criteria for latent poisoning will not only help clinical diagnosis and treatment, but also attract widespread attention and the attention of relevant departments, so that comprehensive measures can be taken to do a good job of prevention.4 As scientific research, industrial and agricultural production fail to pay attention to environmental protection, the air, water sources and soil are polluted by occupational poisons, which is one of the main reasons for hidden poisoning among the general public. B2 Food pollution
B2.1 Poisons directly contaminate food, and consumers are poisoned without knowing it, such as pesticides contaminating vegetables and fruits, and seeds soaked in pesticides are processed as food, etc.
B2.2 Poisoning caused by eating poultry, livestock or fish that have been contaminated by poisons, such as Japanese water retention disease. B2.3 Using containers containing poisons to hold food and drinks, such as using inferior tin pots (high in lead content) to hold wine, causing lead colic caused by lead poisoning, etc. B2.4 Using poisons as condiments, fermentation agents, etc., such as using sodium nitrite as salt, sodium fluorosilicate as baking soda, and ethylene glycol as a beverage, etc.
B2.5 Eating inappropriate items, such as the "Hukou disease" in Jiangxi, which is caused by eating cotton oil without proper heating, and eating "fireworks salt" causing thallium poisoning.
B3 Water source pollution
B4 Air pollution
Abuse of poisons
Using poisons on clothes, bedding, etc. as insecticides and disinfectants, and absorbing poison through the skin. Using folk remedies, folk prescriptions or other drugs to cause poisoning, such as using folk medicines containing lead to treat epilepsy, and using folk medicines containing arsenic and mercury to treat psoriasis. B6
Iatrogenic factors
For example, mistakenly using Sanisol to mix milk, using sodium nitrite as saline for enema, etc. B8 Murder
Murder with poisons, the victim is poisoned unknowingly. Appendix C
(Suggested Appendix)
Instructions for the correct use of the standard
C1 Acute latent poisoning--Once the cause is confirmed to be chemical poisoning, the diagnosis should be handled in accordance with GB16852.1, and the diagnostic standards for target systems (organs) of occupational acute poisoning can also be referred to. C2 Finding clues that the patient has acute chemical poisoning is a key breakthrough point in diagnosis. This standard includes the diagnosis methods, steps and sources of possible clues of acute latent poisoning as Appendix A, and the common causes of acute latent poisoning as Appendix B for reference and application.
C3 Epidemiological survey
In the case of mass disease, epidemiological surveys can provide scientific data for clarifying the cause, the law of disease occurrence and development, and the factors affecting the condition and prognosis. In some cases, it is one of the important methods to solve latent poisoning and can be applied according to the situation. C4 Pathological examination of the body
For suspected acute chemical poisoning patients who could not be clearly diagnosed before death, or for patients whose acute chemical poisoning diagnosis was basically clear before death but some important issues could not be explained, a physical examination should also be performed. Physical examination can systematically observe the pathological changes of various organs, make pathological diagnosis and determine the cause of death.
However, since many acute poisonings caused by poisons do not show specific pathological changes in physical examination, it is still necessary to use multiple methods to clarify the cause of the disease, which is still a necessary basis for diagnosis.
During physical examination, the content of pathogenic substances in major organs should be measured as much as possible. C5 Prevent "false diagnosis" and "abuse diagnosis", and expose "false diagnosis" When being highly alert to the possibility of acute chemical poisoning, attention should be paid to preventing "false diagnosis" and "abuse diagnosis". "False diagnosis" refers to the diagnosis of chemical poisoning when there is a history of exposure to poisons but no poisoning has occurred. "Abuse diagnosis" refers to the diagnosis of chemical poisoning when the history of exposure to poisons is not clear and there is no poisoning. Both of these situations are misdiagnosis, and more attention should be paid to prevent them when multiple people are poisoned. "False diagnosis" means that the doctor gives a diagnosis of chemical poisoning to achieve a certain purpose even though he knows that the person is not poisoned. This diagnosis is forged, so it is called a false diagnosis. This is a serious violation of medical ethics and the law, and it must be exposed once discovered. Therefore, obtaining clues that may be acute chemical poisoning is only the first step, just clues, not conclusions. Further work must be done to collect more materials before a diagnosis can be made. C6 Asking a good medical history and doing a good physical examination are even more important in the diagnosis of latent poisoning, and must be carried out conscientiously. During the entire diagnostic process, accurate and complete materials are the only basis for making a diagnosis. The materials must be accurate, and inaccurate materials will lead to erroneous analysis and judgment. The materials must also be complete, and avoid relying on isolated materials as the only basis for diagnosis, even if they are specific. C7 The development of diagnostic criteria for latent poisoning will not only help clinical diagnosis and treatment, but also attract widespread attention and the attention of relevant departments, so that comprehensive measures can be taken to do a good job of prevention.
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