Thallium poisoning
Introduction
Introduction to cockroach poisoning Most of the thallium poisoning (thalliumpoisoning) is caused by oral administration of strontium salt or topical sputum ointment for the treatment of hair lice (which is not used in China). A few cases are caused by misuse of scorpion-containing poisonous mice, insecticides and anti-mosquito drugs. The poisoning of sputum is mainly caused by hair loss, gastrointestinal symptoms and nerve damage. Serious poisoning eventually leads to multiple organ damage and death. basic knowledge The proportion of sickness: 0.00001% Susceptible people: no specific population Mode of infection: non-infectious Complications: acute toxic encephalitis headache narcolepsy coma respiratory failure hematuria proteinuria
Cause
Cause of poisoning
Oral or topical barium salt (30%):
Most of the strontium salts are colorless, odorless and have good solubility. Therefore, oral administration and poisoning are also one of the ways for sputum poisoning patients to contact sputum compounds. The topical sputum ointment is used to treat hair lice (which is not used in China). A few cases are caused by misuse of scorpion-containing poisonous mice, insecticides and anti-mosquito drugs.
Occupational factors (30%):
Daily contact intake is an important factor leading to sputum poisoning. The bismuth compound can be absorbed through the skin or absorbed through the hair follicles, respiratory mucosa, and the like throughout the body surface. Cases have shown that exposure to sputum dust for 2 hours may lead to acute sputum poisoning.
Environmental factors (30%):
Soil and drinking water pollution caused by mining and other reasons may also lead to residents suffering from acute or chronic sputum poisoning through dietary intake of bismuth-containing compounds. According to the history of contact and the development of the disease, sputum poisoning can be divided into acute sputum poisoning and chronic sputum poisoning. Acute sputum poisoning is a poisoning reaction caused by a large amount of sputum intake in a short period of time. Most of the contact routes are oral.
Pathogenesis:
The monovalent strontium ion is chemically similar to potassium ion, and competes with potassium ions in the living body, affecting the physiological activities involved in potassium ions, such as the conduction of nerve impulses. It binds to the sulfhydryl knot in the mitochondrial membrane, inhibits oxidative phosphorylation, and binds to cysteine sulfhydryl groups to affect the synthesis of keratin, resulting in hair, nail growth disorders, hair loss and mess. The combination of strontium and riboflavin interferes with the process of biooxidation and causes peripheral neuritis. It interferes with DNA synthesis and inhibits mitosis. can damage the fetus through the placenta and pass through the blood-brain barrier.
Prevention
poisoning prevention
Strengthen safety production education, strengthen the management of strontium salt, and prevent poisoning incidents. Actively do a good job in production equipment to help seal and ventilation in the production workshop. Those who are engaged in the relevant industries should wear protective masks or gas masks, gloves, protective clothing, and showers after work. Pay attention to personal protection and avoid inhalation and direct contact with the skin. It is strictly forbidden to misuse salt and misuse salt.
Complication
Sputum poisoning complications Complications acute toxic encephalitis headache narcolepsy coma respiratory failure hematuria proteinuria
Acute sputum encephalitis can occur, headache, lethargy, coma, shock, shock, difficulty breathing, hair loss and even respiratory failure, severe death, hematuria, proteinuria, dry skin scales, The nail has Mee's pattern, the vision is reduced, and the rush is shrinking.
Symptom
Symptoms of sputum poisoning Common symptoms Insufficient diarrhea, toenail showing cock... Polyneuritis, urinary coma, posterior optic neuritis, kidney damage, depression, hair loss
Acutely poisoned children who take large amounts of strontium salts often develop symptoms within hours to 24 hours.
Gastrointestinal symptoms
Mainly for nausea, vomiting, stomatitis, abdominal pain, diarrhea, hemorrhagic gastroenteritis (or constipation). Oral sputum salt patients may have inflammatory symptoms such as tongue salt, pharyngitis and esophageal salt due to contact with the throat during oral administration.
2. Nerve damage
Neurological symptoms often occur 2-5 days after acute sputum poisoning. Mainly there are acral nerve pain, limb sensory disturbance, muscle weakness. Some patients develop acute camphor, with headache, lethargy, confusion, hallucinations, convulsions, tremors, convulsions, and coma. Coma is a characteristic manifestation of large doses of sputum poisoning. Chronic sputum poisoning is characterized by ataxia, paresthesia, and can cause peripheral neuropathy, causing muscle weakness and muscle atrophy.
3. Skin symptoms
Hair loss is a prominent feature of sputum poisoning. Generally appear 1 to 3 weeks after acute poisoning, manifested as alopecia areata or total alopecia, may also be associated with eyebrow removal. Hair loss is generally reversible, and severe poisoning can lead to permanent hair loss and affects whiskers, manes, pubic hair and eyebrows. There may also be rashes, erythema of the palms, hemorrhoids, dry skin diseases, and nails appearing pale or horizontal stripes or falling off.
4. Cardiovascular symptoms
Poisoned patients may have sinus tachycardia, hypertension, angina pectoris, anemia, leukocytosis, eosinophilia, lymphopenia, etc.
5. Eye symptoms
Patients with sputum poisoning may also have optic nerve damage, manifested as retrobulbar optic neuritis, optic atrophy, ocular inflammation, eyelid inflammation, vision loss, and even blindness.
6. Other symptoms
Severely ill children may also have pulmonary edema, difficulty breathing, respiratory failure, shock, etc., and may die within a few days. Kidney damage, may have hematuria, proteinuria. In addition, poisoned people may also have dementia, thyroid dysfunction, developmental retardation and testicular atrophy.
Examine
poisoning check
Urine check
The currently accepted method for the diagnosis of sputum poisoning is to take the urine of the patient for 24 hours and perform atomic absorption spectrometry. Urinary biliary tract increased, urinary fistula increased. Protein, urine sugar, hematuria, tube type, etc. may also appear in the urine.
2. Other poison detection pathways
Poison and stomach wash can analyze the poison. The presence of barium salts can be detected in the stool.
3. Auxiliary inspection
The electrocardiogram showed non-specific ST segment and T segment changes. Leukocytes, eosinophils, and lymphocytes decrease in the blood.
Diagnosis
Diagnosis and identification of sputum poisoning
By investigating the patient's exposure history, hair loss, neurological symptoms, white nails and other horizontal stripes, as well as urine and blood poison detection can achieve the purpose of identification with other metals.
First, laboratory inspection
(1) Bloody
Because the half-life of sputum in the blood is very short, it peaks at 4 hours after one contact, and drops significantly after 4 to 5 days. By 5 to 7 days, 99% of the intake has disappeared from the blood, so bloody sputum is only in acute contact. Only after a short period of time to test can have a reference value; the application value of chronic exposure is relatively worse.
Normal blood stasis is less than 2g / L (<9 78nmol = "" l=""> 40g / L (19.nmol / L) more suggestive of acute sputum poisoning, the symptoms are obvious blood stasis levels are more than 100g / L (0.49 mol/L) or more.
(two) urinary fistula
Normal human urinary tract is more than 5 g / L (0.0245 mol / L, atomic absorption spectrometry). Some studies have suggested that when the urinary tract exceeds 100g/24h (0.49mol/24h), there is an excessive amount of acute sputum contact, but the clinical symptoms are more than 200g/24h (0.98mol/24h). Therefore, most scholars believe that the diagnostic value of urinary fistula for acute sputum poisoning is limited to 200g/24h (0.98mol/24h); urinary sputum in severe poisoning can reach 10mg/24h.
However, for occupational and environmental exposure, the urinary fistula is less than 20g/L, and there is no clinical symptom of poisoning. Therefore, it is considered that the biological contact limit is 20g/L. The diagnostic lower limit of chronic sputum poisoning urinary fistula is still controversial and there is very little information. Therefore, it is currently advocated that its biological exposure limit is the starting point for diagnosis, and clinical manifestation is used as the diagnostic grading basis.
Second, diagnosis and grading diagnosis
China has formulated the National Diagnostic Criteria for Occupational Sputum Poisoning (GB264-2002, GB287-2002), and classifies poisoning into acute and chronic categories:
(1) Acute poisoning
According to the exact occupational exposure history, typical clinical manifestations and on-site hygiene survey data, and exclude the similar diseases caused by Guillain-Barré syndrome, hematoporphyria, and other causes; blood stasis and urinary fistula are significantly increased It can be used as an important reference indicator for acute sputum poisoning. The condition can be divided into four levels:
1. Contact reaction: Dizziness, headache, fatigue, nausea, vomiting, abdominal pain, burning sensation of the pharynx after contact, urinary sputum content increased, but no obvious signs; this performance has not been included in the scope of legal occupational diseases.
2. Mild poisoning: Any of the following manifestations based on the above performance: 1 numbness, hyperalgesia, pain, tactile sensation or achilles tendon reflex in the distal extremities (especially the lower extremities); 2 neuromyography shows Neurogenic damage.
3. Severe poisoning: The above symptoms are aggravated and have one of the following manifestations: 1 toxic encephalopathy or toxic psychosis; 2 obvious muscle atrophy at the distal extremities and affecting motor function, or multiple cranial nerve damage; 3 EMG display Neurogenic damage and more spontaneous denervation potential; 4 with obvious heart, liver or kidney damage.
The newly revised standard is intended to show that the appearance of hair loss and the appearance of the nail is one of the mild poisoning manifestations. Increase the level of moderate poisoning, which is characterized by peripheral nerve symptoms up to elbow, upper knee, acute organ injury, or mild toxic encephalopathy or mental illness, or cranial nerve damage; severe poisoning with obvious muscle strength Decreased motor dysfunction, or the occurrence of moderate-to-severe toxic encephalopathy or psychosis, or obvious organ failure as a basis for diagnosis.
(2) Chronic poisoning
According to the occupational history of long-term sputum operation, it has clinical manifestations such as nervous system damage, hair loss, and persistent high urinary tract. It can be diagnosed by combining on-site hygiene survey data and excluding other diseases caused by other causes. Also divide the condition into three levels:
1. Observed subjects with one of the following clinical manifestations: 1 generalized weakness, lower extremity weakness, limb numbness and other symptoms; 2 neuro-electromyogram showed suspicious neurogenic damage without typical symptoms and signs of peripheral nerve damage; Increased urinary fistula. However, the subject has not yet been included in the scope of statutory occupational diseases.
2. Chronic mild poisoning has one of the following clinical manifestations: 1 heel, plantar hyperalgesia, lower limb symmetrical sock-like pain, touch or tone and vibration disorder; 2 Achilles tendon reflex weakening; or the above performance is slight, but nerve An electromyogram shows neurogenic damage; 3 optic neuropathy or retinopathy; 4 alopecia.
3. Chronic severe poisoning has one of the following clinical manifestations: 1 distal limb sensory disturbance, Achilles tendon reflex disappeared, limb muscle strength decreased significantly, affecting motor function; or limb muscle strength decreased significantly, affecting motor function; or limbs far End muscle atrophy; electromyography showed neurogenic damage, with slower nerve conduction velocity or significantly reduced evoked potential; 2 optic atrophy; 3 toxic encephalopathy; 4 toxic psychosis.
