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Ocupational Poisoning

Ocupational Poisoning. By : Dr ASLANI OCCUPATIONAL MEDICINE SPECIALIST. Content. Definition Etiology Types of Toxicity Lead Mercury. Introduction. Introduction. HEAVY METALS. CHEMICAL PESTICIDES. ORGANIC SOLVENTS. Gases and vapors. Types of Toxicity. Acute toxicity

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Ocupational Poisoning

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  1. Ocupational Poisoning By : Dr ASLANI OCCUPATIONAL MEDICINE SPECIALIST

  2. Content • Definition • Etiology • Types of Toxicity • Lead • Mercury

  3. Introduction

  4. Introduction

  5. HEAVY METALS

  6. CHEMICAL PESTICIDES

  7. ORGANIC SOLVENTS

  8. Gases and vapors

  9. Types of Toxicity • Acute toxicity • Chronic toxicity • Irritation and corrosivity • Sensitization • Carcinogenicity • Reproductive toxicity

  10. Types of toxicity continues • Mechanisms of toxicity: • Direct local toxicity to tissues first in contact with the substance • Systemic effects due to the absorption of the substance

  11. Occupational toxicity deals with the chemicals found in the place of work. • Persons working in various industries may be exposed to various agents during • the synthesis, • or through their use during the occupation.

  12. Lead

  13. Lead metal • Soft • Malleable • Corrosion resistance • Low melting point 13

  14. Some Sources of Lead Exposure

  15. Battery manufacturing Chemical industry Gasoline additives production Foundry workers Welders Jewelers Lead miners Pigment manufacturing Plastics industry Pottery workers Radiator repair Soldering of lead Rubber industry products Occupational exposure

  16. Lead in the Environment • Varies from place to place • Soil near roadways • Elevated in soil, water, or air near lead mining or smelting facilities • Near smaller businesses and industries that involve lead

  17. Routes of Entry • Lead gets into the body by the following routes of entry: • Inhalation (breathing) • Ingestion (swallowing) • Skin absorption

  18. Inhalation • Inhalation is the primary route of entry for lead. • Occurs when lead dust or fume is released into the air and inhaled. • welding on steel coated with lead-based paint • Approximately 40 to 50 percent of the lead that is inhaled is absorbed into the body

  19. Ingestion • Lead-based paint was banned from residential because of lead poisoning in children.

  20. Skin absorption • Certain lead compounds can be absorbed through the skin (TEL).

  21. Toxicology Absorption • Respiratory (30 to 40 % ): • Gastrointestinal systems: (10 to 15% ) adults < children • Cutaneous

  22. Toxicology IncreasedAbsorption: Deficient in calcium Iron Phosphorus zinc

  23. Neurological Effects Gastrointestinal Effects Health effects of lead Heme Synthesis Other Renal Effects ReproductiveEffects

  24. Acute Inorganic Lead Toxicity Acute Inorganic Lead Toxicity: Excessive exposure in brief period Acute lead poisoning syndrome. Classic clinical findings : Abdominal colic Constipation Fatigue hemolytic anemia CNS dysfunction. in profound case: Acute encephalopathy with Coma Convulsions papill edema In milder exposures : headaches personality changes

  25. Acute Inorganic Lead Toxicity Acute Inorganic Lead Toxicity: Abdominal colic (lead colic) • it has sometimes been misdiagnosed as • appendicitis, • peptic ulcer, • biliary colic, • pancreatitis, • pelvic inflammatory disease

  26. Chronic Inorganic Lead Toxicity Late effects : Chronic renal failure Hypertension Gout Chronic encephalopathy Classic abdominal colic of acute lead poisoning is absent. Symptoms: Arthralgias Headache Weakness Depression Loss of libido Impotence Sperm count dec.

  27. Physical Exam Lead line

  28. Heath Effects vs Symptomology • Some workers may experience symptoms at lower blood lead levels while others may tolerate very high levels without showing symptoms

  29. Organs and Systems Affected by Lead

  30. Hematologic toxicity Anemia induced by lead:

  31. Effects on the Nervous System • Damage to the brain may also result in behavioral problems, i.e., • Poor memory • Reduced intelligence • Instability of mood(40-70µg/dl) • Visual disturbances • Confusion • Encephalopathy (a degenerative brain disease) may occur.

  32. Effects on the Nervous System • Peripheral neuropathy: • Weakness and/or paralysis of the hands or legs can cause "wrist drop" or "foot drop". • Motor-sensory neuropathy • Asymmetry • NEW • Months to years of high dose lead • exposure (eg, blood lead concentrations >80 μg/dL) may be associated with a • predominantly motor peripheral neuropathy

  33. Effects on the Kidneys • Often damage is not detected until it’s too late • Increase BUN and Cr. until 50-70%of the nephron destroyed. • NEW • Months to years of high dose lead • exposure (eg, blood lead concentrations >80 μg/dL) may be associated with a • predominantly nephropathy • characterized by interstitial fibrosis and • nephrosclerosis.

  34. Lead and hypertension • Increase mortality heart disease and stroke

  35. Effects on the Reproductive System • FemaleReproductive Health andPregnancy: • Reduces fertility • Spontaneous abortion

  36. Organic lead skin absorption Acute or sub acute CNS symptoms and signs (TEL): Early symptoms: insomnia, anorexia, muscle irritability severe poisoning: Agitated encephalopathy, delirium tremens , cerebellar signs( tremor, ataxia), increased DTR. CSF examination usually is normal.

  37. LAB FINDING • Whole blood lead concentration: is the most common and useful laboratory test to confirm exposure • Noninvasive K x-ray fluorescence measurement of lead in bone: a biomarker of long-term cumulative lead exposure, is used predominantly as a research tool. • Measurement of lead in urine following a dose of a chelating agent (chelation challenge testing): correlates satisfactorily in most cases with blood lead test results, and is seldom indicated in clinical practice.

  38. LAB FINDING An elevation in erythrocyte protoporphyrin (often measured as zinc protoporphyrin or ZPP): reflects lead-induced inhibition of heme synthesis. Because there is a time lag of several weeks associated with lead-induced elevation in ZPP, the finding of a blood lead of ≥30 μg/dL with no concurrent increase in ZPP suggests that the lead exposure was of recent onset.

  39. OSHA standard • whole BLL : • 1.every 6 months if BLL <40 µg/dl • 2.every 2 months If BLL>40 µg/dl until 2times BLL <40 µg/dl • 3.monthly during removal • Removal from exposure: • 1. worker BLL>60 µg/dl • 2. worker average BLL >50 µg/dl • 3. worker at risk of health impairment

  40. OSHA standard • NEW • Current OSHA lead standards that require medical removal from elevated workplace lead exposure when blood lead levels exceed 50 or 60 μg/dL were enacted several decades ago and offer insufficient protection

  41. OSHA standard • NEW • An expert panel in 2007 recommended that removal be initiated for a single blood lead level greater than 30 μg/dL, or when two successive blood lead levels measured over a 4-week interval are ≥20 μg/dL. • The longer-term goal should be for workers to maintain blood lead levels <10 μg/ dL

  42. Primary Prevention of Lead Poisoning Engineering controlsSubstitution of less hazardous material Isolation via containment structure Ventilation via local exhaust systemPersonal protective equipmentRespirator utilizationWork practices Personal hygiene practices Periodic inspection/maintenance of control equipment

  43. Mercury

  44. Mercury

  45. Exposure • elemental mercury:is a liquid at room temperature with a substantial vapor pressure • Inorganic mercury salts:(mercuric sulphide (HgS), mercuric oxide (HgO) and mercuric chloride (HgCl2)) • organic mercury: • short-chain alkyl: methyl mercury salts • long-chain alkyl • non-alkyl organic compounds: phenyl mercury

  46. General consideration • Toxicity: • Specific form and compounds • Route of exposure • Dose • Age • Bind to sulfhydryl groups and interfere with numerous cellular enzyme systems.

  47. Elemental mercury • Heavy shiny silver-white metal • liquid or vapor at room temperature

  48. Elemental mercury • Occupational exposure: • Extraction of mercury & silver & gold • Burning fossil fuels (high- sulfur coal) • Maintenance work on furnaces, flues • Chloralkali production plants ( use of mercury in the electrolysis of salt) • Dentist & dental technicians

  49. Elemental mercury • Absorption: • Inhalation is major route of exposure (pulmonary retention is more than 80%) • Skin and gastrointestinal absorption are poor (0.1%) • Heating increase absorption • Elimination : - urine

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