GBZ 81-2002 Diagnostic criteria for occupational phosphorus poisoning
Some standard content:
National Occupational Health Standard of the People's Republic of China GBZ 81-2002
Diagnostic Criteria of Occupational Phosphorus Poisoning2002-04-08 Issued
2002-06-01 Implementation
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 GB17059-1997 and this standard, this standard shall prevail. Exposure to yellow phosphorus in occupational activities can cause acute or chronic poisoning, which is both related and different, and has different pathogenesis and clinical manifestations. This standard is formulated to protect the health of contacts, standardize the diagnosis of phosphorus poisoning, and effectively prevent and treat phosphorus poisoning.
This standard is based on the principle of uniformity of occupational disease diagnosis rules, the same target organ damage of exogenous diseases, and consistency of clinical manifestations. When compiling the diagnostic standards for acute phosphorus poisoning with chemical liver damage as the main clinical manifestation, the diagnostic and grading standards in GBZ59 and GBZ51 are cited: in the differential diagnosis points and the routine functional tests of acute and chronic liver diseases, this standard is also implemented with reference to this standard.
This standard is based on the industry advantage that the occupational hazardous workers have health records and are systematically followed up. In order to make a good differential diagnosis of diseases, especially when the early clinical manifestations of poisoning are difficult to distinguish from common diseases, the diagnostic grading standards for chronic phosphorus poisoning are compiled with the guiding ideology of special observation for special populations and finding the relationship between progressive changes in diseases and continuous exposure. Appendix A of this standard is an informative appendix, and Appendix B is a normative appendix. This standard is proposed and managed by the Ministry of Health of the People's Republic of China. This standard is drafted by the Liaoning Provincial Occupational Disease Prevention and Control Institute and the Yantai Municipal Occupational Disease Prevention and Control Institute of Shandong Province. Guangxi Zhuang Autonomous Region Occupational Disease Prevention and Control Institute, Wuhan Chemical Industry Occupational Disease Prevention and Control Institute, Shandong Province Labor Health Occupational Disease Prevention and Control Institute, Shandong Province Zibo City Occupational Disease Prevention and Control Institute and Shandong Medical University Stomatology Department participated in the drafting. The Ministry of Health of the People's Republic of China is responsible for the interpretation of this standard. Occupational phosphorus poisoning diagnostic standard
GBZ81-2002
Occupational phosphorus poisoning refers to a systemic disease caused by workers' exposure to yellow phosphorus in their occupational activities. Acute phosphorus poisoning is caused by liver and kidney damage caused by short-term exposure to large doses of yellow phosphorus or yellow phosphorus burns; chronic phosphorus poisoning is caused by long-term exposure to teeth and mandible damage, which may be accompanied by liver and kidney damage. 1 Scope
This standard specifies the diagnostic standard and treatment principles for occupational phosphorus poisoning. This standard is applicable to poisoning caused by exposure to yellow phosphorus in occupational activities, and is not applicable to poisoning caused by red phosphorus, purple phosphorus, black phosphorus, etc. This standard can also be used as a reference for poisoning caused by exposure to yellow phosphorus in non-occupational activities. 2 Normative references
The clauses in the following documents become the 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 reaching 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.
3 Diagnostic principles
Diagnostic criteria for occupational toxic liver disease
Diagnostic criteria for occupational chemical skin burns 3.1 Acute phosphorus poisoning can be diagnosed only based on the occupational history of inhaling a large amount of yellow phosphorus vapor or yellow phosphorus burns in a short period of time, clinical manifestations mainly characterized by acute liver and kidney damage, and comprehensive analysis and exclusion of similar diseases caused by other causes. 3.2 According to the occupational history of long-term close contact with yellow phosphorus vapor or yellow phosphorus dust, there are clinical manifestations of progressive periodontal tissue, tooth and mandibular damage, and there may also be liver and kidney damage. Combined with the comprehensive analysis of on-site labor hygiene data, similar diseases caused by other causes are excluded before they can be diagnosed as chronic phosphorus poisoning. 4 Observation subjects bzxZ.net
After long-term close contact with phosphorus vapor or yellow phosphorus dust, periodontal atrophy, deepening of periodontal pockets, loose teeth, etc., and X-rays of the mandible show mild absorption of the alveoli on both sides, which are horizontal. 5 Diagnosis and classification standards
5.1 Acute phosphorus poisoning
5.1.1 Mild poisoning
Symptoms such as headache, dizziness, fatigue, loss of appetite, nausea, and pain in the liver area appear several hours after inhaling high-concentration yellow phosphorus vapor or about 1 to 10 days after yellow phosphorus burns, and there is liver enlargement and tenderness, accompanied by abnormal liver function tests, which is consistent with acute mild toxic liver disease; there may be hematuria, proteinuria, and tubular urine, which is consistent with acute mild toxic nephropathy. 5.1.2 Moderate poisoning
The above symptoms are aggravated, and one of the following conditions occurs: obvious enlargement and tenderness of the liver, obvious abnormal liver function, which is consistent with acute moderate toxic liver disease; a
b) Renal insufficiency, increased urea nitrogen and plasma creatinine, which is consistent with acute moderate toxic nephropathy. 5.1.3 Severe poisoning
On the basis of the above clinical manifestations, one of the following conditions occurs: a) Acute liver failure:
b) Acute renal failure.
5.2 Chronic phosphorus poisoning
5.2.1 Mild poisoning
After clinical dynamic observation for more than one year, after symptomatic treatment, the above symptoms are progressively aggravated, alveolar bone absorption exceeds 13 of the root length, the periodontal ligament space widens, narrows or disappears, the bone plate thickens, and the bone texture in the mandibular body is thickened or thinned, and the arrangement is disordered: there may be respiratory mucosal irritation and digestive system symptoms. 5.2.2 Moderate poisoning
The above manifestations are aggravated, and symmetrical bone density shadows appear in the posterior teeth area of the mandible, with unclear perimeters, possible pores, and blurred edges. 5.2.3 Severe poisoning
On the basis of the above clinical manifestations, mandibular necrosis or fistula formation occurs. 6
Treatment principles
6.1 Treatment principles
6.1.1 Acute phosphorus poisoning
6.1.1.1 Etiological treatment
After inhaling high concentration of yellow phosphorus vapor, you should leave the scene quickly and move to a place with fresh air.a)
After yellow phosphorus burns the skin, it should be immediately rinsed with clean water to extinguish the phosphorus fire, remove the yellow phosphorus particles embedded in the tissue, and prevent the absorption of yellow phosphorus. Refer to GBZ51 for treatment. 6.1.1.2
Symptomatic and supportive treatment
Adrenocortical hormones, oxygen free radical scavengers, calcium channel blockers, etc. can be appropriately selected; b)
Pay attention to maintaining water, electrolytes and acid-base balance c)
For toxic liver disease, use symptomatic treatment such as liver protection and nutritional therapy: For toxic nephropathy, pay attention to preventing and treating hypovolemia, improving renal microcirculation and other symptomatic treatment and supportive treatment, and blood purification therapy can be used when necessary.
Chronic phosphorus poisoning
Pay attention to oral hygiene, treat various oral diseases in time, and repair teeth as soon as possible: 6.1.2.1
Pay attention to surgical treatment for mandibular osteonecrosis or osteomyelitis: 6.1.2.2
Pay attention to protecting liver and kidney functions, and give symptomatic treatment. 6.1.2.3
6.2 Other treatments
6.2.1 Acute phosphorus poisoning
After mild poisoning is cured, the person should be temporarily transferred away from yellow phosphorus work. After moderate and severe poisoning is cured, the person should generally not engage in yellow phosphorus work. 6.2.2 Chronic phosphorus poisoning
6.2.2.1 After mild poisoning is cured, the person can engage in the original work. If the condition is progressively aggravated, the person should be transferred away from yellow phosphorus work. 6.2.2.2 The person should be transferred away from yellow phosphorus work if the condition is moderate and severe poisoning. Instructions for the correct use of this standard
See Appendix A (Informative Appendix) and Appendix B (Normative Appendix). Appendix A
(Informative Appendix)
Instructions for the correct use of this standard
A.1 This standard applies to occupational acute and chronic poisoning caused by yellow phosphorus. Acute phosphorus poisoning is mainly caused by liver and kidney damage, and consciousness disorders may occur in severe poisoning; chronic phosphorus poisoning is mainly caused by tooth and mandibular damage, which may be accompanied by liver and kidney damage. In clinical observation, the condition should be observed and evaluated from a holistic perspective, and attention should be paid to the damage of yellow phosphorus to multiple organs of the body. A.2 Acute phosphorus poisoning
A.2.1 Yellow phosphorus burns are often treated with 1% to 2% copper sulfate to clean the wound and extinguish phosphorus fire, but excessive use can cause acute copper poisoning and lead to hemolysis, so special attention should be paid to this side effect; it is now recommended to use 2% to 3% silver nitrate solution to clean until there is no phosphorus fire. A.2.2 Yellow phosphorus poisoning can occur when the burn area is small, and liquid yellow phosphorus burns of 5% can be fatal. Lesions of organs such as the liver and kidneys may occur about 1 to 10 days after the burn, and these situations should be taken seriously; the grading indicators should be implemented according to the diagnostic steps and grading standards for acute toxic liver and kidney diseases. A.2.3 Routine liver function tests in acute phosphorus poisoning can refer to GBZ59 for testing. A.2.4 Renal function tests in acute phosphorus poisoning can be tested with urea nitrogen, plasma creatinine, urine sodium and urine volume. A.2.5 In acute phosphorus poisoning, blood phosphorus may increase and blood calcium may decrease, but since the test results are affected by other factors, they are not listed as classification indicators.
A.2.6 This standard proposes the treatment principles for liver disease caused by acute phosphorus poisoning, which can be implemented with reference to GBZ59. A.3 Chronic phosphorus poisoning
A.3.1 Chronic phosphorus poisoning currently lacks sensitive and specific diagnostic indicators, and a diagnosis cannot be made based on a single examination. Dynamic observation and treatment must be carried out to provide complete and comprehensive clinical data on the annual changes in teeth, jaws and liver after exposure to yellow phosphorus, self-control, combined with occupational history, and the results of yellow phosphorus concentration measurement in the workshop air, a comprehensive analysis is carried out, and differential diagnosis is made before a clear diagnosis can be made; those who have liver damage on the basis of oral diseases can be treated according to the relevant provisions of GBZ59. A.3.2 Chronic phosphorus poisoning causes periodontal, dental and mandibular lesions, which tend to occur on the bilateral posterior teeth, often multiple teeth, and are often bilaterally symmetrical, mostly on the mandible. After more than one year of treatment, the disease continues to worsen, and is often accompanied by respiratory mucosal irritation symptoms and digestive system symptoms. This can be distinguished from non-occupational oral diseases, because non-occupational oral diseases are mostly single or double-tooth diseases with irregular and asymmetrical locations, and are rarely accompanied by other systemic symptoms. A.3.3 According to domestic and foreign data, chronic phosphorus poisoning may cause liver and kidney damage. Because there are very few cases, liver and kidney damage is not used as a diagnostic grading standard for the time being. Although liver and kidney damage is rare, it cannot be ignored. Therefore, when conducting physical examinations on yellow phosphorus producers, attention should be paid to the overall health of the body, and health monitoring should be done if conditions permit. A.3.4 Chronic mild toxic liver disease Liver function tests such as ALT and AST are usually normal, serum bile acid determination and indocyanine green retention test (ICG) are more sensitive; renal function tests can be performed with urine routine, urine protein quantification and urine sodium determination, etc., and observation items can be selected according to clinical conditions.
A.4 Phosphorus has four allotropes, namely yellow phosphorus (also known as white phosphorus), red phosphorus (also known as red phosphorus), purple phosphorus, and black phosphorus. Among them, yellow phosphorus is the most toxic, and the rest are very small in toxicity. If the product contains impure yellow phosphorus, it may cause phosphorus poisoning. Therefore, the name of the allotrope containing yellow phosphorus should be indicated in brackets after diagnosis to distinguish it from poisoning caused by pure yellow phosphorus. B.1 Sitting (standing) side view of the mandible
B.1.1 Film 5X7 placed horizontally.
B.1.2 Distance 55~60cm.
Appendix B
(Normative Appendix)
Requirements for X-ray Examination of Mandible
B.1.3 Positioning method: The patient sits (stands) in an inverted position in front of the photography stand, with the mandible on the side to be examined close to the photography stand, with both arms placed beside the body, and the mandible placed on a dark box on a stand tilted 30 degrees to the side to be examined. The jaw is extended forward, and the mandible to be examined is as parallel to the dark box as possible, with the front edge of the dark line including the mandibular symphysis, and the lower line is aligned with the lower edge of the mandible. B.1.4 The center line is tilted 30 degrees to the head side and aligned to 5 cm below the mandibular angle on the opposite side. B.2 Supine side view of the mandible (this method can be used if there is no standing photography stand) B.2.1 Film 5X7 is placed horizontally.
B.2.2 Distance 60cm
Position method: The patient lies on his back on the photography table, with his arms at his sides and his head turned to the side to be examined. The shoulder to be examined is raised with a pillow or sandbag. To avoid the overlap of the cervical spine and the mandible, the jaw is extended forward, and the body of the mandible to be examined is laid flat and as parallel to the cassette as possible. The front edge of the cassette includes the mandibular joint, and the lower line is aligned with the lower mandibular line. B.2.4 The center line is tilted 30 degrees to the head side and is aligned with 5 cm below the mandibular angle on the opposite side. B.3 Darkroom requirements
The developer and fixer should be prepared according to the formula in the instructions of the X-ray film used. The development time is 4 to 6 minutes. The temperature of the solution is between 18 and 22 degrees Celsius.
B.4 Film quality requirements
B.4.1 According to the requirements of the X-ray film being developed, the mandible on the side being examined should be clearly displayed and not deformed (too wide or too narrow). The mandible on the opposite side should not overlap, and 4 to 5 teeth should be displayed. B.4.2 The structure of the teeth, periradicular and jawbone should be clearly displayed. B.5 In chronic poisoning, both the upper and lower jaws can be damaged, but the mandible is more common. If the diagnosis of the disease requires it, the corresponding parts of the teeth and maxilla should be taken.
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