Vous êtes sur la page 1sur 30

DNIPROPETROVSK STATE MEDICAL

ACADEMY
DEPARTMENT OF OCCUPATIONAL
DISEASES
OCCUPATIONAL DISEASES CAUSED BY
INTOXICATION WITH NITROCOMPOUNDS AND
OILSPERSES OF BENZOL
-R.SUBASARAVANAN
 Nitrocompounds and oilsperses of Benzol are rather widely used in chemical
industry for the production of organic dyes, pharmaceutical preparations,
explosive matters, reagents and some pesticides.
 These compounds include aniline, , Nitrobenzene, Dinitrobenzene, Nitrotoluene
 Aromatic oilsperses and nitrocompounds of the benzol line transform into
aminophenol in the organism. In liver, they are neutralized by attachment with
glucuronic acid and sulphuric acid with the creation of non-toxic vapor compounds,
which are discharged by kidneys with urine.
PATHOGENESIS:
1. FORMATION OF METHEMOGLOBIN
2. FORMATION OF SULFHEMOGLOBIN
3. FORMATION OF BODIES OF GEINS - ERLIKH
4. SECONDARY HEMOLYSIS AND HEMOLYTIC ANEMIA
1.FORMATION OF METHEMOGLOBIN:
• Nitrocompounds and oilsperses of the benzol line are methemoglobin forming.
Under the impact of these matters, blood pigmenthemoglobin is transformed into
methemoglobin, which has dark brown color. Methemoglobin differs from the
normal hemoglobinby the fact that bivalent iron hema is reverse and under the
impact of oxidants, it transforms into a trivalent form, losing its ability to attach
and transport molecular oxygen to tissues. Hypoxemia and hemic hypoxia develop.
Nowadays, it is considered that pathological pigment is not created by the very
aromatic nitrocompounds and oilsperes, but products of their transformation in the
organism (phenyl-hydroxyl and nitrobenzene).
2.FORMATION OF SULFHEMOGLOBIN:
• When poisoning with various aromatic nitrocompunds and oilspereses,
methemoglobin disappears from blood after the termination of the impact of these
matters within 2 to 6 days, renewing into an active form of heboglobin. Under
appropriate conditions, oxidation of α-methyl group of porthyrin with further
attachment of sulfur atom to pyrol rings progresses. Along with this, a pathological
derivate of hemoglobin is created – sulfhemoglobin, which can also attach
molecular oxygen. However, comparatively with methemoglobin, it is an
irreversible pathological pigment, which is saved in erythrocytes until the end of
their life cycle. Thus, presence of sulfhemoglobin in the blood is an important
diagnostic criterion of the toxic influence of aromatic nitrocompounds and
oilspereses.
3. FORMATION OF BODIES OF GEINS – ERLICH:
• Toxic impact of aromatic nitrocompound and oilsperses onto blood is
accompanied by not only the creation of methemoglobin and sulfhemoglobin, but
also with the appearance of inclusions in the form of oval grain, which are called
bodies of Geins – Erlikh. Protein granules, created from denaturated protein after
dissociation of hemoprotein onto heme and globins are believed to take place. The
number of bodies depends on the intensiveness of toxic impact. They appear more
often just in several days after the beginning of intoxication. It is always a sign of
a very deep damage of erythrocytes. Thus, in the basis of the creation of bodies of
Geins – Erlich, there is denaturation and sedimentation of the pigment.
4. SECONDARY HEMOLYSIS AND HEMOLYTIC ANEMIA:
• The duration of life of erythrocytes with bodies of Geins – Erlich is reduced; they
undergo mass ruining. Acute hemolytic anemia takes place, signs of which are the
decrease of osmotic resistance of erythrocytes and the level of hemoglobin, ruining
of erythrocytes and the increase of the content of indirect bilirubin, and marked
urobilirubinuria. In the blood, there is a big amount of reticulocytes and even
normoblasts. Changes of leucopoiesis are characterized by moderately marked
neutrophilic with shifting to the left.
• Thus, for poisoning with aromatic nitrocompounds and oilspereses of the benzol
line, specific changes in blood are characteristic, like methemoglobinemia,
sulfhemoglobinemia and presence of bodies of Geins and Erlich with further
secondary hemolysis and the development of hemolytic anemia.
• Besides, these compounds influence nervous system (like strong narcotic poisons
they impact vitally important centers – respiratory, vasomotor and
thermoregulatory centers); liver (directly on hepatocytes, assisting the
accumulation of free fatty acids, triglycerides, lipids with the development of fat
infiltration of cells, which is accompanied by the formation of strong cell poisons –
alcohols, ketones, aldehydes and causes disorganization of cell metabolism and
denaturation of proteins); cardiovascular system (directly onto the heart muscle –
hypoxemic effect); skin and urinary tracts.
PATHOLOGIC AND ANATOMIC PICTURE:
• Skin, mucous tunic of conjunctiva, tongue, and gums become pale gray, or pale
yellow. Dot hemorrhages, and sometimes single ulcers are possible.
• Blood becomes chocolate brown. Internal organs are plethoric. Marked fatty
degeneration of liver can be observed, epithelium of intertwined channels are
changed in a degenerated way and it contains hemosiderin. Spleen is increased,
and is marked with deposits of hemosiderin.
• Acute poisoning is characterized by the change of marrow. Yellow bone marrow
is replaced with functioning red one.
• For chronic poisoning, sclerotic changes in all internal organs are characteristic.
CLINICAL PICTURE:
ACUTE POISONING:
According to the clinical picture, there are three types of acute poisoning:
1. Mild
2. Moderate
3. Severe
MILD ACUTE POISONING:
• In case of mild poisoning, presence of cyanosis of lips in some areas, nail plates
on fingers. Face skin is pale with grayish shade. Patients complain to have
weakness, drowse, and headache. The content of methemoglobin does not exceed
15 % of the general content of hemoglobin. In 1 to 2 hours after the termination of
work, these phenomena disappear.
MODERATE ACUTE POISONING:
• With poisoning of moderate phase, the symptoms of intoxication are marked more.
Well-marked skin and mucous tunic cyanosis takes place. Unusual coloration of
skin and mucous tunic is conditioned by the increase methemoglobin in blood;
creation of sulfhemoglobin and reduced hemoglobin. Patients complain to have
acute headache, drowsiness, noise in ears, blinking in eyes, the state of shock,
and sometimes loss of consciousness and decrease of muscle tone. Heart tones
are dull and the pulse is accelerated. The content of methemoglobin achieves 30 to
40 % of the general content; the blood gets chocolate brown color; viscosity is
increased and ESR is decreased.
• When poisoning with nitrobenzene and dinitrochlorbenzene, high level of
methemoglobin is for 4 to 6 days, and when poisoning with aniline it is for 2 to 3
days.
• In 3 to 4 days, pathological phenomena of the central nervous system weaken, but
some changes in the peripheral nervous system can take place (pain in limbs and
feeling of shivering.
SEVERE ACUTE POISONING:
• In case of a severe form of acute poisoning with aromatic nitrocompounds and
oilsperses, changes of blood go through the following three stages:
1) Stage one: Formation of methemoglobin and bodies of Geins- Erlich, which
appear in blood on the 2nd – 5th day after intoxication.
2) Stage two: Hemolysis of degeneratively changed erythrocytes. The number of
erythrocytes decreases sharply; the content of hemoglobin decreases; the content
of indirect bilirubin increases. The term of progressing of this stage is from 5 to 8
days.
3) Stage three: Renewal of the blood content. Sharp increase of the number of
reticulocytes takes place; basophile – grainy erythrocytes emerge; a general
number of erythrocytes and the content of hemoglobin increase.
• The renewal of the blood content takes place without utilization of specialized
treatment methods. Complete renewal of blood is carried out for 3 to 4 weeks.
With acute poisoning, in particular, with nitrobenzene, the development of toxic
hepatitis is possible. Slight increase of the liver is observed; dyspeptic phenomena
increase, like nausea, vomiting, and loss of appetite. On the 3rd – 5th day,
icteritiousness of sclera and mucous tunics appear. Skin becomes pale with yellowish
shade of coloration. In blood, there is direct slowed down reaction of bilirubin; and
bile pigments – in urine are observed. The progress of toxic hepatitis is non-malignant.
By the end of 2nd or 3rd week of hepatitis is subject to a reverse development. Severe
acute poisoning with aromatic nitrocompounds and oilsperses can be met very rarely
in industrial conditions. In the clinical pattern, there are mostly general brain
phenomena, loss of consciousness and coma. In case of getting out of coma,
retrograde amnesia, disorientation, obnubilation, headache and drowse can be
observed. Pulse is from 120 to 150 beatings a minute; and the arterial pressure is
lowered down. Sometimes, the content of methemoglobin is from 60 to 70 % in blood.
CHRONIC POISONING:
• Chronic poisoning with aromatic nitrocompounds and oilsperses of the benzol line
should include more or less stable diseases, which appear in case of prolonged
impact of small dosages of these production poisons. Under their chronic impacts,
biggest disorders can be observed from the side of such systems like blood,
nervous system, liver and esophagus.
• Toxic anemia is characterized by the development of stable anemia, for which it is
characteristic to have the decrease of the Colour Index and reticulocytosis, and
the presence of 5 – 7 % methemoglobin is observed, and up to 1.5 %
sulfhemoglobin and bodies of Geins-Erlich.
• Change in leukocytes count. At first leukocytosis, and then leukopenia develops.
Oxygen capacity of blood decreases significantly due to the decrease of the ability
of hemoglobin to attach oxygen.
• Affection of the nervous system can be characterized by complaints of patients to
have headache, drowsiness, general weakness, worsening of memory, increased
fatigability, sleep disorder, restlessness, and apathy. From the side of vegetative
nervous system, hyperhydrosis and labiality of the arterial pressure are observed.
Further, functional changes on the side of the central nervous system progress and
transit into the microorganic symptoms system with the involvement of
hypothalamus, as well as the development of hypothalamic syndrome.
• Toxic hepatitis is shown through complaints of the sick to have pain, heaviness in
the right hypochondrium, bitterness in the mouth, and non- perception of fat
food. When examining a patient, moderate increase and pain in the liver, and in
some cases, positive symptoms in gall bladder can be observed. The research of the
functional state of the liver, as a rule, shows affections of hydrocarbon, anti-toxic,
pigment, protein forming, excretory and other functions of this organ
• Disorder of pigment exchange at toxic hepatitis is rather specific. Light
hyperbilirubinemia (without a clinical pattern of jaundice), which is characteristic
for these patients, conditioned by the decrease of the fraction of free bilirubin,
which appears due to low activity of the ferment of β- glucoronidase. In case of
moderately marked chronic toxic hepatitis, the activity of such organ specific
enzymes for the liver, like ornithine- carbamyl-transferase, fructose
bisphosphate-aldolase, and D-sorbitol-6- phosphate-dehydrogenase does not
increase. There is also no disorder of fat exchange – the content of lipoproteins
and cholesterol do not leave the boundaries of physiological waves.
• Duodenal probing shows the absence or the weakening of cystic reflex, changes
of the chemical composition of the B bile, in particular the decrease of the
concentration of cholesterol and bilirubin. At cholecystography, there are
disorders of the movement function of the gall bladder.
• At chronic intoxications of with aromatic nitrocompounds, pathological process
involves the esophagus as well.
• Patients complain to have scattered pain in the suprastomach area after eating,
nausea, belching, sometimes with “rotten egg” sensation, constipation,
abdominal distension, and instability of defecation.
• Functional and morphological research of the stomach enables to diagnose
functional secretory and motor disorders, and more seldom, gastritis with mostly
saved acidity. From the side of pancreas, decrease of the activity of pancreatic
enzymes in the duodenal content and the increase of their concentration in blood
can be observed, but these changes bear functional character.
• As to the heart and vascular system, patients suffer from the pain in heart, heart
beating, and dyspnea at physical strain. Research of cardiovascular system
enables to find the weakening of tones, inconstant systolic murmur on the top of
the heart and the inclination to hypertension.
• Changes of sight are characteristic only for some representatives of aromatic
nitrocompounds – nitro derivative of toluene (trinitrotoluol). Bilateral toxic
cataract of I – II degrees develops.
• In case of prolonged action of some aromatic oilspereses (benzidine and β-
naphthylamine), chronic irritation of the mucous tunic of the urinary bladder with
products of metabolism of toxic matters (hemorrhagic cystitis, papilloma and
malignant tumor of the urinary bladder) takes place. This disease can develop
without symptoms for a long time and can be diagnosed only during cystoscopy.
• At the action of such aromatic nitrocompounds and oilspereses, like Ursol,
dinitrochlorbenzene, there is a threat of developing of allergic disease – bronchial
asthma, dermatitis and eczema. There are cases of the change of the skin and hair
coloration among those who work in contact with nitrocompounds and oilsperes of
benzol for a long time. These matters are rather closely connected with proteins of
skin and hair and dye them into brown when contacting with aniline, or in yellow –
when contacting with trinitrotoluene.
TREATMENT:
ACUTE POISONING:
 In case of development of acute intoxication, it is necessary to take the patient
out of the contaminated zone.
 If toxic matters got to the skin, it is necessary to take off the contaminated clothes
and to rinse the skin thoroughly with warm water and soap or a weak solution of
potassium permanganate.
 Periodical inhaling of oxygen (from 20 to 30 minutes) is carried out for 5 to 10
hours.
 It is possible to alternate oxygen inhaling with carbogenes (5 to 7 minutes),
which excites the respiratory center, improves the ventilation of lungs and assists
the dissociation of oxyhemoglobin.
 Good results are observed when prescribing cystamine, lipoid acid and ascorbic
acid, intravenously, 10 to 30 ml of the preparation of “Chromosmone” (1 %
solution of methylene blue in 25 % solution of glucose), 30 to 50 ml of 40 %
solution of glucose, 20 to 30 ml of 30 % solution of sodium thiosulfate.
 At severe poisoning, artificial replacement of blood is used (3 to 4 liters) with the
purpose to reduce the concentration of toxic matters and their metabolites,
dilatation and reduction of blood viscosity. With this purpose, it is possible to
conduct a forced diuresis.
 Incase of appearance of acute hepatitis, it is recommended to administer vitamins
of Group B, tocopherol acetate, as well as lipotropins.
CHRONIC POISONING:
 Treatment of patients with chronic intoxication should be complex with the
consideration of the general state of a patient, as well as the major affection of
corresponding systems and organs.
 If functional disorders of the central nervous system have been found, it is
recommended to administer sedatives, and in case of hypothalamic syndrome,
intranasal ionophoresis or medical ionization is prescribed: the solution of 10 %
calcium chloride, 2 % Dimedrol, and 5 % sodium bromide’ with the inclination to
arterial hypotonia – a complex of vitamins of the group B, eleuterokok, Chinese
Schizandra and beloid are prescribed.
 To get rid of hypoxemia and hypoxia, oxygen therapy is carried out.
 At toxic hepatitis, Diet No. 5, as well as lipotropic preparations (choline chloride),
essentiale and legalon are recommended. Positive results are given by repeated
duodenal probing, prescription of cholagogue preparations (alcohol, cholenism
and hips). Patients with marked dyskinesia, bile-excreting tracts are prescribed to
administer papaverine, no-shpa, platyphyllin and atropine.
 Treatment for disorders of functions of stomach and kidneys should be individual
with the consideration of the phase of progressing of the disease, character of
changes of the secretory and movement functions, the degree of morphological
changes of the mucous tunic. Diet, vitamins and physiotherapy, as well as
therapeutic exercises, small dosages of insulin (6 to 8 units) in combination with
glucose (20 ml of 40 % solution) intravenously are prescribed.
VERIFICATION OF THE ABILITY TO WORK:
 At mild poisoning, patients are not able to work for a short period of time (for
several days).
 At acute intoxication of moderate and severe degrees, temporary inability to work
is 3 to 4 days. Then with the purpose to ensure the results of the treatment of
patients, they are transferred to lighter work beyond the impact of toxic matters with
the provision of a sick leave on occupational inability to work for 1 to 2 months.
Further, they are considered capable to work according to their speciality.
 In cases of mild chronic intoxication to ensure the treatment effect, patients are
recommended to be transferred to another temporary position outside the impact of
toxic matters for the period of 2 months with the additional payment if needed to
provide average monthly payment according to the sick leave on the occupational
inability to work. Further, they are permitted to work according to their occupation,
but only under condition of keeping to sanitary and hygienic norms of labor.
 If the disease is a relapse, patients should be re-employed rationally (without the
loss of qualification) at another place, which is more favorable in industrial
meaning. In case of impossibility of such employment, a decision is made on
temporary provision of invalidism group (for 1 to 2 years) due to the occupational
disease until a new profession is not acquired.
 At the moderately marked form of intoxication, further working contact with toxic
matters is not recommended, and patients are subjects to rational employment; and
in case of the reduction of the qualification – they should be sent to the Expert
Commission to acquire an invalidism group.
PREVENTIVE MEASURES:
 The basis of preventive measures is further limitation of the contact with toxic
matters.
 It can be achieved due to mechanization of production processes, sealing-in the
equipment and reconstruction of ventilation.
 Wet cleaning should be done in premises.
 All those who work in possible contact with these matters, should use individual
protection and should have an opportunity to take a shower at work.
 Those, who are being employed or employees who contact with oilspereses and
nitrocompounds of benzol, should go through preliminary and periodical medical
examinations.

Vous aimerez peut-être aussi