GBZ 3-2002 Diagnostic criteria for occupational chronic manganese poisoning
Some standard content:
ICS13.100
National Occupational Health Standard of the People's Republic of China GBZ3—2002
Diagnostic Criteria of Occupational Chronic Manganism2002-04-08 Issued
Ministry of Health of the People's Republic of China
2002-06-01 Implementation
Article 5.1 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 the original standard GB3232-1982 is inconsistent with this standard, this standard shall prevail. In occupational activities with long-term exposure to manganese, chronic manganese poisoning is often caused by improper protection. In order to protect the health of the contactors and effectively prevent and treat chronic manganese poisoning, GB3232-1982 was issued. This standard highlights the damage of manganese to the central nervous system and mainly diagnoses and grades it according to the degree of damage. 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 was drafted by the Shenyang Occupational Disease Prevention and Control Institute, the Labor Hygiene Research Institute of Anshan Iron and Steel Company and the Guizhou Occupational Disease Prevention and Control Institute.
This standard is interpreted by the Ministry of Health of the People's Republic of China. ..comDiagnostic criteria for occupational chronic manganese poisoning
GBZ3-2002
Occupational chronic manganese poisoning is a disease caused by long-term exposure to manganese smoke and dust, with changes in the nervous system as the main feature. Early manifestations include neurasthenia syndrome and autonomic dysfunction. When the poisoning is more obvious, extrapyramidal damage occurs, and may be accompanied by mental symptoms. In severe cases, it may manifest as Parkinson's syndrome and toxic psychosis. 1 Scope
This standard specifies the diagnostic criteria and treatment principles for occupational chronic manganese poisoning. This standard applies to the diagnosis and treatment of occupational chronic manganese poisoning, and non-occupational chronic manganese poisoning can also refer to it. 2 Diagnostic principles
Based on the close history of occupational exposure and clinical manifestations dominated by extrapyramidal damage, the work environment survey, on-site air manganese concentration measurement and other data should be referred to for comprehensive analysis to exclude other diseases such as tremor paralysis and hepatolenticular degeneration before diagnosis.
3 Observation subjects
have symptoms of neurasthenia syndrome such as dizziness, headache, easy fatigue, sleep disorders, forgetfulness, as well as limb pain, lower limb weakness and heaviness. If one of the following conditions is present, the person may be listed as an observation subject. a) There are manifestations of autonomic dysfunction such as sweating and palpitations; b) Urine manganese or hair manganese exceeds the upper limit of the normal value in the region. 4 Diagnosis and classification standards
4.1 Mild poisoning
In addition to the above symptoms, a person with one of the following conditions may be diagnosed with mild poisoning: a) Definitely increased muscle tone:
Although the muscle tone is not definite, there is obvious tremor in the fingers and hyperreflexia of the tendons: There are also mental and emotional changes such as easy excitement, emotional instability, and lack of interest in surrounding things. 4.2 Severe poisoning
Severe poisoning can be diagnosed if one of the following conditions is present: Obvious extrapyramidal damage
Manifested as Parkinson's syndrome: Increased muscle tension in the limbs, accompanied by resting tremor, which can induce cogwheel rigidity: Inflexible and inaccurate finger or rotation test, positive sign of difficulty standing with eyes closed, speech disorder, or abnormal gait, difficulty in retreat and other movement disorders may occur:
b) Toxic psychosis
There are significant changes in mental mood, such as emotional indifference, slow reaction, involuntary crying and laughing, strong ideas, impulsive behavior, etc. 5 Treatment principles
5.1 Treatment principles
In the early stage, metal chelating agents such as calcium disodium edetate can be used for treatment, and symptomatic treatment can be given appropriately. When obvious extrapyramidal damage or toxic psychosis occurs, the treatment principles are the same as those of neuro-psychiatry. ..com5.2 Other treatments
5.2.1 Observation subjects
Review once every six months to one year, conduct dynamic observation, and appropriately treat according to the development trend of the disease. 5.2.2 Poisoned patients
Anyone diagnosed with manganese poisoning, including cured patients, shall not continue to engage in manganese operations. Mildly poisoned patients can be arranged for other work after recovery; severely poisoned patients need to rest for a long time. 6 Instructions for the correct use of this standard
See Appendix A (Informative Appendix) and Appendix B (Normative Appendix). Appendix A
Instructions for the correct use of this standard
(Informative Appendix)
A.1 Manganese poisoning should be differentiated from neurasthenia, peripheral neuritis, mental illness, tremor paralysis, sequelae of encephalitis, hepatolenticular degeneration, complications of acute carbon monoxide poisoning, cerebral arteriosclerosis, senile tremor and other diseases. A.2 There are currently no specific laboratory diagnostic indicators for manganese poisoning. Urine manganese and hair manganese mentioned in this standard can only be used as exposure indicators. Although the manganese content in biological materials is not high, if the occupational history is clear, the symptoms and signs are typical, and other diseases can be excluded, it should be diagnosed.
A.3 Whether there is definite increase in muscle tension is the key to diagnosing manganese poisoning. For those with obvious increase in muscle tension, it is not difficult to determine during the examination. When the increase in muscle tension is not obvious, it must be carefully tested repeatedly, and if necessary, it must be checked by multiple people before it can be determined. Those who can be determined to have increased muscle tension are called definite increased muscle tension. ..comAppendix B
Method for determining manganese in biological materials
(Normative Appendix)
The existing method for determining manganese in biological materials is not ideal. The following recommended method is for reference in work in various places: B.1 Urine manganese determination method
The potassium periodate manganese collection method is introduced below (refer to Zhou Hengfeng, editor-in-chief: "Occupational Poisoning Inspection", page 147, People's Medical Publishing House, 1976).
B.1.1 Principle
After adding ammonia water to the urine manganese, all the manganese will accumulate in the phosphoric acid precipitate, and then be inorganicized with nitric acid. Finally, potassium periodate will be used in a dilute nitric acid solution to oxidize the manganese into purple-red permanganate, and then the determination will be made by colorimetry. B.1.2 Reagents
Ammonium hydroxide (analytical grade).
Nitric acid (analytical grade).
1:1 phosphoric acid (analytical grade).
25% nitric acid.
Potassium periodate (chemically pure).
10% potassium sulfate nitric acid solution.
Manganese standard storage solution (1 ml is equivalent to 0.1 mg). Manganese standard application solution (1 ml is equivalent to 0.01 mg). h)
B.1.3 Operation steps
Take 250 ml of 24-hour mixed urine, place it in a 500 ml conical flask, add 20 ml of concentrated ammonia water, mix well, and leave overnight. a)
b) The next day, pour off the upper layer of urine as much as possible (do not lose the precipitate), add 5ml of concentrated nitric acid to the precipitate, and heat it over low heat to evaporate it. When it is slightly cool, add 1ml of nitric acid, cover the bottle mouth with a 5cm watch glass, heat until thick yellow smoke comes out of the bottle, remove the cover and turn off the heat. When it is slightly cool, add another 1ml of nitric acid. After covering, heat until yellow smoke comes out. Remove the cover and turn off the heat after the yellow smoke basically disappears. If the residue has not completely turned white, add another 1ml of nitric acid and continue digesting until it turns white. c) Add 5ml of 25% nitric acid to the residue (you can also slightly heat it to help dissolve it). Pour it into a 16x110mm test tube, then wash the flask with 2ml of distilled water, and pour the washing liquid into the test tube together. d) Add 0.5ml of 1:1 phosphoric acid and mix well.
e) Add 0.3g of potassium periodate and shake well. Place it in a boiling water bath for 15 minutes, take it out and let it cool, and centrifuge it for precipitation. f) At a wavelength of 530 nm, use a blank tube (made of 5 ml of 25% nitric acid, 2 ml of distilled water, 0.5 ml of 1:1 phosphoric acid and 0.3 g of potassium periodate, boiled for 15 minutes at the same time as the measuring tube) to calibrate the optical density to "0", read the optical density reading of the measuring tube, consult the standard curve, and calculate the manganese content in 250 ml of urine, multiply by 4, and you will get the urine manganese (mg/L). g) If no standard curve is used, prepare two standard tubes of 2.5 ug and 10 ug and a blank tube for each measurement (see the method for drawing the standard curve). If the color of the measuring tube is lower than 2.5ug, it can be reported as less than 10ug/l. If it is higher than 2.5ug, the optical density "0" point is corrected with a blank tube. After reading the optical density readings of the measuring tube and the standard tube (10ug), calculate according to the following formula: ×0.01×1.000
Optical density of specimen
Urine manganese (mg/1)=
Optical density of standard tube
B.1.4 Drawing of standard curve
After mixing the tubes in the table, boil them in a boiling water bath for 15 minutes, take them out and let them cool. Use a wavelength of 530nm, use the first tube as a blank tube to correct the optical density to the "0" point, read the optical density readings of each tube, and draw a standard curve. B.2 Manganese determination method
The following introduces the formaldehyde method (refer to the compilation of the Guizhou Institute of Labor Hygiene, page 135, 1980.10.) B.2.1 Principle
After the organic matter of hair is destroyed, manganese is oxidized by air under alkaline (pH10) conditions and becomes tetravalent. It forms a complex with the iron and triformaldehyde coexisting in the hair. The iron complex in the latter is decomposed by reducing agent and EDTA, and then the remaining purple-red manganese complex is measured by colorimetry. B.2.2 Reagents
a) Formaldehyde reagent: Weigh 8g of hydroxylamine hydrochloride (NH2OH·HCI) and dissolve it in 100ml of distilled water, add 4ml of 37% formaldehyde solution, and dilute to 200ml with distilled water. This reagent can be used for 10 days after preparation. b) Ammonia buffer (pH-10): Dissolve 68g of ammonium chloride in 300ml of distilled water, add 570ml of concentrated ammonia water, and dilute to 1L with distilled water.
c) 10% ascorbic acid aqueous solution: (W/V): Prepare before use. 0.1M EDTA solution: 3.7g of sodium edetate (EDTA-2Na) dissolved in 100ml of distilled water. d)
30% hydrogen peroxide solution (analytical grade).
Digestion mixture: Nitric acid and perchloric acid are prepared in a ratio of 3:2. 50% ammonium citrate (W/V): After preparation, adjust the pH to 10 with ammonia water (test with precision pH test paper). g)
50% phosphoric acid solution (W/V).
Manganese standard solution: Accurately weigh 143.8mg of dry potassium permanganate, dissolve it in 50ml of distilled water, and add 1ml of concentrated sulfuric acid. i
Add sodium bisulfite solution while stirring until the purple-red color of potassium permanganate disappears. Boil slowly to allow sulfur dioxide to escape. After cooling, transfer to a 1L volumetric flask and accurately add distilled water to 1L. This solution contains Mn50ug/ml. During the test, dilute this solution into 5ug/ml manganese standard application solution. Test tube number
Each tube has the equivalent manganese content, ugwww.bzxz.net
Manganese standard solution (10μg/ml), ml
Manganese standard solution (100μg/ml), ml
25% nitric acid, ml
Distilled water, ml
1:1 phosphoric acid, ml
Potassium periodate, g
B.2.3 Operation steps
a) After the hair sample is soaked in 5% detergent, rinse it with water for 5 to 6 times, then rinse it with deionized water for 3 to 4 times, and dry it in an oven at 105℃.
b) Cut the processed hair sample into about 4--5mm for later use: weigh 0.5g of the hair sample and place it in a 100ml conical flask, add 5ml of digestion mixed acid and 2 glass beads, slowly heat on an electric stove, keep it slightly boiling, and remove it when thick white smoke comes out of the flask. Add 1ml of 30% hydrogen peroxide solution, and yellow-green gas will be generated. Continue to heat until it is transparent (if the solution is not transparent enough when it smokes, add a few drops of hydrogen peroxide), and evaporate to dryness. Remove the conical flask, cool it down, add 3ml of deionized water along the wall of the flask, rinse the residual perchloric acid on the wall of the flask, and then heat and evaporate to dryness until the perchloric acid is completely driven off. c) After cooling, drip 5.7ml of deionized water along the wall of the flask to dissolve the residue, add 2 drops of 50% phosphoric acid and 1ml of 50% ammonium citrate, and mix well. Add 1ml each of formaldehyde enteric reagent and ammonia buffer, stir well, and let it stand for 5 minutes to fully develop color. d) Add 0.3ml of 10% ascorbic acid solution and 1ml of 0.1M EDTA solution, mix thoroughly, and leave for 15 minutes to decompose the iron complex. Pour the solution into a colorimetric cup, use the blank reagent as a reference, measure its optical density at a wavelength of 450nm, consult the standard curve, and calculate the concentration of starting manganese. B.2.4 Drawing of the standard curve
Put 0, 0.5, 1.0, 2.0, 4.0, 8.0, and 12.0ug of manganese standard application solution in a 10ml color tube, add water to 5ml, add 2 drops of 50% phosphoric acid, 1ml of 50% ammonium citrate, and mix well. The following steps are the same as B.2.3, and finally add water to the 10ml mark on the color tube. Draw the colorimetric results of the above tubes into a standard curve. The optical density of the colored solution remains unchanged within 1 hour.
B.3 The increase in manganese content in biological materials must be determined after multiple (more than 3) inspections. The value is determined based on the normal value in the area.
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