GB 8788-1988 Occupational acute poisoning by chlorinated and nitro compounds of benzene (except trinitrotoluene) Diagnostic criteria and treatment principles

GB 8788-1988 Occupational acute poisoning by chlorinated and nitro compounds of benzene (except trinitrotoluene) Diagnostic criteria and treatment principles GB8788-1988 standard download decompression password: www.bzxz.net

National Standard of the People's Republic of China
Diagnrastic: criterin andl principles of rnanagenent afoceupatlonal acute aromatle amino- and nitro-compouads (exeluding TNT) polsoningUDC 616-057 : 616
-07/-08 547
-546/.547
GB 878888
Occupational acute toxicity to amino and nitro compounds is a systemic disease with methemoglobinemia, hemorrhagic anemia or liver damage as the main pathological changes caused by the absorption of a large amount of amino and nitro compounds of benzene through the skin or inhalation in a short period of time. Diagnostic principles
Based on the occupational exposure history, corresponding clinical manifestations, combined with labor and health survey data, comprehensive analysis is carried out to exclude similar diseases caused by other causes before diagnosis can be made.
2 Diagnosis and classification standards
2.1 Mild toxicity
Mild purple fuzz on the lips, ears, tongue and fingernails (toenails), with possible headache, fatigue and chest tightness. Methemoglobin is 10%-30%. - Generally returns to normal within 24 hours.
2.2 Moderate Moderate
If any of the following is present, it can be diagnosed as severe poisoning: obvious purpura of the skin and mucous membranes, palpitations, shortness of breath, loss of appetite, nausea, vomiting and other symptoms may occur, methemoglobin is typically between 30% and 50%;
b Mild hemolytic anemia, Hernzi bodies may be less than 20%, chemical urticaria.
2.3 Severe poisoning
If any of the following is present, it can be diagnosed as severe poisoning; a.
Severe purpura, lead-gray skin and mucous membranes, impaired consciousness, methemoglobin higher than 50%. Severe hemolytic anemia, Hernzi bodies may be higher than 50%; more serious liver and kidney damage.
3 Treatment principles
3.1 Leave the scene quickly. Remove skin viable frames and observe closely. 3.2 Special treatment: methemoglobinemia can be treated with methylene blue. 3.3 Symptomatic supportive therapy, principle of medical treatment. Approved by the Ministry of Health of the People's Republic of China on February 22, 1988 and implemented on September 1, 1988
4 Assessment of work capacity
GB 8788
a. Mild and moderate poisoning can be cured and resumed after a short rest. b. Severe poisoning should be transferred away from the work of contacting nitrogen-based and nitro compounds after recovery. 5 Requirements for health examination
5.1 Workers working with amino and nitro compounds should undergo a pre-employment physical examination, including detailed medical examination, liver function, urine routine, blood routine examination, etc.
5.2 Workers engaged in the operation of benzene nitrogen base and nitro compounds should have a physical examination every year. In addition to the same examination items as the pre-employment physical examination, if conditions permit, they may also have methemoglobin, ectopic bodies and urine aminophenol determination. 5
Occupational contraindications
Liver and kidney diseases;
Caffeine,
Chronic skin diseases, such as chronic eczema and psoriasis that do not heal for a long time. A.1 Source
GB8788--88
Appendix A
Quantitative determination of methemoglobin
(Supplement)
Methemoglobin has a unique absorption band at a wavelength of 630nm. When a cyanide is added, the methemoglobin is converted into cyanide hemoglobin: this absorption band also disappears immediately. Therefore, the difference in absorbance before and after adding the phosphate is measured with a spectrophotometer (or photoelectric colorimeter), and the maximum value of the red egg heart of the high iron surface is calculated according to the standard. A.2 Reagents
1/15M sodium hydrogen phosphate solution: accurately weigh NaiFTPO,-[211O23.87g, dissolve and dilute to 1L with distilled water. b.1/15M potassium dihydrogen phosphate solution, accurately weigh KHPO.9.07g, dissolve and dilute to 1L with distilled water, 1/60M pH 6.6 phosphate buffer: take 1/15M sodium hydrogen phosphate solution 3.75ml 1/15M potassium dihydrogen phosphate solution c
6.25ml, distilled water 30 ml. Mix and use (this solution is prepared when used). d.5 (w/w) potassium (sodium) phosphate solution.
5% (H/) potassium ferrocyanide solution
1% triton x-1n (polyoxyethylene ether of hydroxybenzoic acid). r.
A.3 Operation steps
Take 2 small test tubes, numbered "^" and "B", add 4.5ml of 1/60M pH 6.6 phosphate buffer to each tube. 40ml of the blood sample to be examined, and 0.5ml of 1% triton x-100. "A\ tube is dried at 630nm wavelength, adjusted with phosphate buffer or distilled water, and the absorbance is measured at 630nm, then 50ul of 5% potassium (sodium) phosphate solution is added. Mix well, let stand for 2min, and measure the absorbance at the same wavelength as D. "B" chain is added with 50ul of 5% potassium ferric hydride solution. After 2-5min, the absorbance at 630nm is measured as D, then 50ul of 5% potassium (sodium) phosphate solution is added, filtered, let stand for 2min, and measure at the same wavelength as D. The absorbance is obtained. A.4 Calculation method
Methemoglobin/total methemoglobin)
A.5 Method description
Send-×100
A.5. After the formation of methemoglobin, due to the presence of reductase in red blood cells, methemoglobin can be gradually reduced and subsided. Therefore, it is necessary to collect samples immediately. If the samples cannot be analyzed at present, the anticoagulated blood can be directly collected into the buffer solution and stored for 2·4 (freezing time not more than 10 h), bring back to the laboratory for determination. Heparin is the best anticoagulant, and oxalic acid is prohibited because it will induce the formation of methemoglobin. A.5.2 This method must use a spectrophotometer with strong resolution, and the wavelength of the spectrometer must be tested for accuracy before use. A.5.3 After the reagent is added to the whole blood, the blood cells are destroyed. Due to the presence of small fragments, the solution becomes turbid, affecting the absorbance (especially negative values ​​for normal people). The use of non-ionized surfactant triton xl diluent or a centrifugation step can overcome the turbidity of hemoglobin.
B.1 Method
Nile blue direct push film method.
B.2 Principle
GB 8788--88
Appendix B
Echinosome examination method
(Supplement)
After being exposed to certain amino and nitro compounds of benzene, it can cause the denaturation of red blood cell special proteins. After staining with Nile blue, blue-purple or blue-green cells will appear on the edge of the red blood cells, with a diameter of 0.3-2 um, round or oval with light-dispersing bodies (lighter color bands can be seen around), which are not seen in normal red blood cells.
B.3 Reagentsbzxz.net
Take 0.5g of Nile blue and dissolve it in 90% or anhydrous ethanol, grind it, then add the solution to 1U0ml, filter it after it is completely dissolved and set aside. B.4 Equipment
Fat-free glass slide, push slide.
B.5 Operation method
B.5.1 Take 1-2 drops of 0.5% Nile blue dye solution and drop it in the center of the fat-free glass slide, dry it and set aside. B.5.2 Take a drop of fresh blood from the subject and drop it into the dye solution that has been dropped. Use a corner of the push slide to gently mix the blood and dye solution evenly for about 30 minutes, then push it into a thin slice, dry it and examine it with an oil immersion lens. B. 6 Counting method
The number of Hernández bodies contained in 1000 red blood cells shall be reported as white fraction. If Hernández bodies are not found in the whole film, it can be reported as "detected by surgery".
c.1 Scope of application of this standard
G8 8788
Appendix C
Instructions for the correct use of the standard
(reference)
This standard applies to acute poisoning caused by industrial production of aniline, nitrobenzene or other amino and nitro derivatives of benzene.
C.2 This standard does not include skin damage caused by nitrogen radicals and nitro compounds of benzene. For diagnosis and treatment, see GB 7804-87 Diagnosis criteria and treatment guidelines for occupational skin diseases. C.3 Methemoglobinemia and Hernández bodies can also be caused by other diseases, such as genetic diseases, drugs or other industrial substances, so they should be excluded in combination with relevant information.
C. 4 In case of mild methemoglobinemia, 1% methylene blue 6 ml (1mg/kg) can be added to 25% dextrose 20 ml and slowly injected intravenously. One time is enough. Vitamin C can be given if necessary. In case of moderate and severe methemoglobinemia,1% methylene blue 6~12 ml (1~2 mg/kg) can be added to 25% dextrose 20 ml and slowly injected intravenously. If necessary, it can be repeated every 8~12 hours for one day. Vitamin C can be given at the same time.
Additional remarks:
This standard is proposed by the Occupational Disease Diagnosis Standard Subcommittee of the National Health Standard Technical Committee. This standard is drafted by Tianjin Labor Health and Occupational Disease Prevention and Control Institute, Shanghai Fifth People's Hospital, Shandong Labor Health and Occupational Disease Research Institute, Dalian Labor Health and Occupational Disease Research Institute. The Ministry of Health entrusted the Institute of Labor Health and Occupational Diseases of the Chinese Academy of Preventive Medicine to interpret this standard. From the date of implementation of this standard, the diagnostic criteria and treatment principles for poisoning of amino and nitro compounds of benzene (excluding trinitrotoluene) issued by the former Ministry of Health (74) Weifang No. 446 shall be invalid.
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