Medical statistics of occupational mercury poisoning. Clinic for mercury intoxication

It is impossible to name branches of the national economy, wherever chemicals are used. They are found in metallurgical production (carbon monoxide, sulfur dioxide, etc.), in the mining industry during blasting, in the metalworking industry, in the production of plastics and synthetic resins. In agriculture, chemicals are widely used for fertilizer and pest control. Finally, the chemical industry occupies a significant place in the national economy.

Some chemicals, under certain conditions, can become a source of acute and chronic poisoning of an occupational nature.

INDUSTRIAL POISONS AND THEIR EFFECTS ON THE ORGANISM

Industrial poisons are chemicals that, when they enter the body of workers in the course of their professional activities in relatively small quantities, cause transient or persistent pathological changes.

Under production conditions, poisons can be used as a raw material (aniline in the production of dyes), they are an auxiliary material (chlorine in the bleaching of fabrics) or

yut in the form of a by-product (carbon monoxide during combustion).

The main route of entry of industrial poison into the body of a worker is the respiratory tract, although in some cases poisoning can occur as a result of the poison entering the body through the alimentary canal and skin.

The respiratory organs with their huge surface (90 m 2) and the insignificant thickness of the alveolar membranes provide exceptionally favorable conditions for the penetration of gaseous and vaporous substances into the blood. The same favorable conditions exist for the penetration of dusty substances, and the danger of poisoning by inhalation depends on the degree of solubility of the dust.

Toxic substances can enter the body through intact skin, sweat and sebaceous glands and the epidermis, and this ability is possessed by non-electrolytes soluble in lipids.

Penetrated in one way or another in the body of toxic substances undergo various kinds of transformations. Organic substances undergo oxidation, hydrolysis, deamination and transamination, reduction, synthetic processes - the formation of harmless paired compounds, etc.

Inorganic substances, in turn, can undergo oxidation or

be deposited, such as lead, fluorine, etc., in the body in the form of insoluble compounds. Heavy metals have the ability to form a depot in it.

The transformations of toxic substances in the body usually contribute to their neutralization and rapid release from the body, although in some cases compounds may be formed that have a harmful effect on the body.

Excretion of poison from the body. The main routes through which toxic substances leave the body are the kidneys and intestines. Metals, halides, alkaloids, dyes, etc. are directly excreted through them.

Volatile substances, such as alcohol, gasoline, ether, etc., are largely excreted through the lungs along with the exhaled air. Substances such as lead, arsenic, can be excreted through the mammary glands. Along the way of their release, toxic substances can leave a mark in the form of secondary lesions (colitis with arsenic and mercury poisoning, stomatitis with lead and mercury poisoning, etc.).

Conditions for the toxic action of poison. The toxic properties of a substance largely depend on its chemical structure. For example, halide organic compounds are the more toxic the more hydrogen atoms are replaced by halides. So, C 2 H 2 Cl 4 (tetrachloroethane) is more toxic than C 2 H 2 Cl 2 (dichloroethane).

For substances with a narcotic effect, toxicity increases with an increase in the number of carbon atoms. Thus, the pathological effect increases from pentane (C 5 H 12) to octane (C 8 H 13); ethyl alcohol (C2H5OH) is less toxic than amyl alcohol (C 5 H 11 O n).

The introduction of the NO 2 or NH 2 group into the molecule of benzene, toluene changes the nature of the action of the substance. The narcotic effect disappears, but the effect on the blood, the central nervous system, and parenchymal organs increases.

Of no small importance in relation to toxic effects is the dispersion of a chemical substance penetrating the body, and the higher the dispersion, the more toxic the substance.

So, zinc and some other metals that are not toxic to humans in coarse dis-

in the persal state, become toxic to it when finely dispersed in the inhaled air. For the same reason, poisons that are in a vapor, gas and smoke state are the most dangerous.

The concentration of a substance in the air or the dose of a substance entering the body through the respiratory tract, skin and alimentary canal is of decisive importance for the manifestation of a toxic effect.

The strength of the poison also depends on the duration of contact with it.

The higher the solubility of a toxic substance in body fluids, the higher its toxicity. Of particular importance is the solubility of the poison in lipoids, since this creates the ability to quickly penetrate into nerve cells.

The combined effect of poisons is very important. The combination of toxic substances in the air of industrial premises and their combined effect on the body are very diverse. In some cases, such a combined effect leads to an increase in the toxic effect, exceeding that of each of the toxic components taken separately, i.e., the so-called synergism is obtained. Thus, the toxic effect of a mixture of nitrogen oxides and carbon monoxide is greater than the simple sum of the effects of these poisons. Ethyl alcohol, as a rule, enhances the toxic effect of many toxic substances.

In other cases, the joint action of poisons can lead to a weakening of the action of one substance by another - a so-called antagonism arises.

Finally, the combined action of toxic substances can lead to a simple summation of their action (additive action), which is most often found in industrial conditions.

A number of environmental conditions can either enhance or weaken the effect of the poison. So, at high air temperatures, the risk of poisoning increases. For example, poisoning with amido- and nitro compounds of benzene is more common in summer than in winter.

High temperature also affects the volatility of the gas, the rate of evaporation, etc. The value of high air humidity has been established to enhance the toxicity of certain poisons (hydrochloric acid, hydrogen fluoride).

Physical work can also enhance the effect of toxic substances, especially those that affect metabolic processes.

From the point of view of the effect of poison on the body, the functional state of the latter, especially the state of its nervous system, is of great importance.

Poisons can either aggravate the course of the disease or change the immunobiological resistance of the organism, i.e., their paratoxic effect may manifest itself.

In case of poisoning with some poisons, a metatoxic effect can be observed, which is understood as the development of pathological processes after the poisoning has already ended. An example is the psychosis that occurs after a previous carbon monoxide poisoning.

Some people have an increased sensitivity to certain poisons (asthmatic attacks when in contact with ursol, etc.).

GENERAL PREVENTION OF OCCUPATIONAL POISONING

A radical measure for the prevention of occupational poisoning is the elimination of poison from production. Thus, the replacement of mercury with silver nitrate for aiming mirrors eliminated mercury poisoning in this production. The same can be said about the replacement of toxic yellow phosphorus in matchmaking with non-toxic red phosphorus. A significant reduction in lead poisoning has been achieved by replacing white lead with zinc oxide, etc.

In some cases, the effect can be achieved by replacing a more toxic substance with a less toxic one, for example, replacing methyl alcohol with another alcohol, benzene with gasoline, etc.

A very effective measure is the technical improvement of industry, on the basis of which a huge reduction in occupational poisonings has been achieved in the USSR. The replacement of melting brass in crucibles by melting in electric furnaces led to the elimination of foundry fever, and the mechanization of loading blast furnaces led to a significant reduction in carbon monoxide poisoning, etc.

A significant effect can be achieved

also by rationalizing the technological process. Thus, the transition to a vacuum process in the chemical industry eliminates the ingress of toxic substances into the air of the working area. The continuous method of production eliminates the release of toxic substances, which occurs with periodically operating equipment, periodic filling and emptying it.

Works associated with the release of harmful gases and vapors must be carried out, if possible, in fume hoods.

It is important that the working opening of the cabinet be as small as possible in area, and the air velocity in it should be in the range from 0.25 to 1.5 m/s. However, fume hoods cannot be used, for example, if tanks and apparatus are loaded by lifting and transport vehicles. In these cases, they resort to the device of onboard suctions (Fig. 65). On one or both sides of the bath, from the surface of which vapors are emitted, slotted holes are arranged above the sides, connected to exhaust ventilation. Vapors rising from the bath are picked up by the air and carried away.

Umbrellas, which are hung over a source of smoke and gases, are very common in industry (Fig. 66).

Such umbrellas are arranged over furnaces and furnaces, and their suction holes are

sional harmfulness. A list of contraindications is given in the relevant instructions.

According to Soviet legislation, workers in hazardous professions enjoy a shorter working day, additional paid leave, and therapeutic and preventive nutrition. Of great prophylactic importance are special diets prepared taking into account the mechanism of action of a toxic substance for workers in contact with certain poisons.

Workers receive therapeutic and preventive nutrition free of charge.

PROFESSIONAL POISONINGS

SOME POISONS AND THEM

PREVENTION

Lead is a heavy metal, melts at 327°C, and at 400-500°C begins to release a significant amount of vapor. Lead and its compounds can pollute the air in lead smelters, batteries, lead paints, printing, etc.

The main way lead enters the body is through the respiratory system. From the pulmonary alveoli, bypassing the hepatic barrier, it enters the general blood stream. But the possibility of lead entering the body through the food canal (hand contamination) is not ruled out. Lead is excreted through the intestines, salivary glands, liver and kidneys.

Under production conditions, only chronic lead poisoning occurs.

A more or less early sign of poisoning is asthenic-vegetative syndrome. An important diagnostic sign of poisoning is the presence in the blood of erythrocytes with basophilic granularity due to irritation of the bone marrow system, as well as the appearance of lead in the urine above 0.48 µmol/l (0.1 mg/l).

In the future, anemia develops, which is sometimes accompanied by hemolytic jaundice. A lead border appears in the form of a grayish-lilac stripe on the gums as a result of the combination of lead with hydrogen sulfide released from mica.

Noah. The complexion acquires a gray tint (lead color).

With lead poisoning, an increased amount of hematoporphyrin, a product of the breakdown of blood pigments, is excreted in the urine and feces.

A later but severe symptom of chronic lead poisoning is excruciating cramping pain, intestinal colic due to spasm of the smooth muscles of the intestines, which can be mixed with acute diseases of the abdominal organs requiring surgical intervention. With lead poisoning, persistent constipation, gastritis, and loss of appetite are observed. Sometimes the peripheral nervous system is affected, in connection with which paresis and sometimes paralysis of the extensor muscles are observed. In advanced cases, the phenomena of encephalopathy are also possible.

Prevention of lead poisoning. In the USSR, the use of lead white in the form of paints, lead linings in the production of files, glazes containing lead compounds, in the porcelain and faience and glass industries is prohibited. In printing houses, plastic type is being introduced instead of lead.

Where it is impossible to completely remove lead from production, it is necessary to take measures to mechanize production processes, arrange local exhaust ventilation in places where lead is released, and thoroughly clean the premises with vacuum cleaners. The sanitary condition of production and household premises requires special attention. Workers are provided with overalls that they should not take home. Overalls should be systematically dusted and washed. After work, workers must take a shower. Hand care is required, especially before eating, as well as oral care.

In industries where lead is used, the work of women and adolescents is prohibited.

Work with lead is contraindicated for persons suffering from active form of pulmonary tuberculosis, severe anemia, arteriosclerosis, hypertension, gastritis, peptic ulcer of the stomach and duodenum, diseases of the intestines, organic diseases.

central and peripheral nervous system.

The maximum allowable concentration for lead is 0.01 mg /m 3 .

Mercury is a liquid shiny metal, boiling at a temperature of 357.2 ° C. Already at room temperature, it evaporates, and the higher the air temperature, the more intense the evaporation and the greater the danger of poisoning.

Mercury is used in the production of thermometers, barometers, mercury rectifiers, and mercury fulminate. Workers may come into contact with mercury in its mining, extraction from gold ores, the use of mercury pumps, in the production of incandescent lamps, in the chemical and pharmaceutical industries, etc.

Under industrial conditions, mercury enters the body mainly in the form of vapors through the respiratory organs, and part of it is retained in the body and forms a depot in the bone marrow, liver, and kidneys. Mercury is excreted from the body through the intestines and kidneys, partly by salivary, sweat and mammary glands. Occupational mercury poisoning is usually chronic.

It is generally accepted that with a concentration of mercury vapor in the air in the amount of 1.5 mg / m 3, acute poisoning can occur, and the symptoms of damage to the alimentary canal come to the fore: salivation, stomatitis, diarrhea mixed with blood; in addition, acute parenchymal nephritis is observed.

As for the clinic of chronic mercury poisoning, here, first of all, damage to the nervous system is noted. More pronounced changes are noted on the part of the alimentary canal, the external signs of damage to which are manifested by mercury stomatitis and a mercury border that differs from lead in a bluish color.

On the part of the stomach and intestines, the phenomena of gastritis and enterocolitis are noted. As a result of malnutrition in severe cases, anemia and malnutrition develop.

The defeat of the central nervous system is manifested initially by tremor. It begins in the form of a small and frequent dro-

squeezing fingers, then goes to the legs, lips, tongue and the whole body. The tremor increases with excitement and voluntary movements, as well as when trying to write.

In severe cases of mercury poisoning, changes in the psyche are observed: the patient is irritable, quick-tempered, he is either excited, or shy, or painfully shy (mercury erethism). Mercury encephalopathies have been described.

Mercury at its high content in the inhaled air can have an effect on the genital area of women and on its generative function. The menstrual cycle is disturbed, pregnancy is often interrupted by spontaneous abortion, and there is a high mortality rate among newborn children.

The described picture of severe mercury poisoning (mercurialism) in the USSR is almost never found at the present time. However, chronic low-dose poisoning can occur, often with severe symptoms. In these cases, there are subjective complaints of headache, dizziness, drowsiness. memory loss, fatigue. Objectively, there is a predominant lesion of the autonomic nervous system.

Tremors are found in patients, a decrease in the swallowing reflex, persistent dermographism, sweating, etc. Gingivitis, bleeding gums, and damage to the teeth are observed from the oral cavity.

Prevention. A radical way to prevent poisoning is to replace mercury with non-toxic or less toxic substances. If this is not possible, measures must be taken to prevent the entry of poison into the workroom.

All work with mercury must be carried out in a specially equipped separate room, the walls and ceilings of which must be painted with oil or nitro-enamel paint, and the floors are covered with linoleum, fixed flush to the walls. Works related to the presence of open mercury, with its heating, should be carried out in fume hoods. Tables and fume hoods should be covered with linoleum and have drains and pockets for mercury to drain. The air temperature in the room should not exceed 16-18 ° C. Equipment for

mercury must be closed. The room where work with mercury is performed must be equipped with supply and exhaust ventilation. In these rooms, it is necessary to establish constant monitoring of the content of mercury vapor in the air. The maximum permissible concentration of mercury vapor is 0.01 mg/m 3 .

Carbon monoxide

Carbon monoxide (CO) is an odorless and colorless gas.

It is the most common industrial poison. It occurs wherever there are processes of incomplete combustion of carbon. It is a part of blast-furnace (up to 30%), coke oven (6%), water (40%), gas generator (30%) and other gases. Smoke contains up to 3%, exhaust gases of internal combustion engines - up to 13%, explosive gases - up to 50-60% carbon monoxide.

Workers may come into contact with carbon monoxide as an industrial poison in many industries (blast-furnace, open-hearth, blacksmith, foundry, thermal shops, production of lighting, water gas), in agriculture when working on tractors, in vehicles, in industries where carbon monoxide is a raw material (synthesis of phosgene, ammonia, methyl alcohol), etc.

As a result of the radical reconstruction of industry and the implementation of radical health measures, the frequency of occupational carbon monoxide poisoning in the USSR has been significantly reduced.

The picture of acute poisoning in mild cases is expressed as follows. There is a beating and a feeling of pressure in the temples, dizziness, headache, chest tightness, weakness, retching. In severe poisoning, there is a loss of the ability to voluntary movements and a darkened consciousness up to its complete loss. The pulse is small, rapid, irregular, heart sounds are muffled, breathing is shallow. Mental arousal, auditory and visual hallucinations appear.

A weakly expressed toxic effect is manifested at a concentration of carbon monoxide in the air in the amount of 60 mg / m 3, severe poisoning occurs at a concentration of 1000-2000 mg / m 3.

At present, the possibility of chronic carbon monoxide poisoning has been proven, and it is manifested by symptoms from the central nervous system (headache, dizziness, insomnia, irritability, etc.). Along with this, there is a lack of appetite, nausea, palpitations, anemia, etc.

Prevention. Preventive measures consist in the mechanization and sealing of production processes. The mechanization of charge loading in blast furnaces alone has led to a huge reduction in the frequency of carbon monoxide poisoning in the iron and steel industry. Along with careful sealing of all gas pipeline systems and equipment, it is necessary to establish control over the gas content in the air in gas hazardous places (automatic alarms, periodic air sampling, etc.). First of all, it is necessary to install local, as well as general ventilation, where possible.

Persons suffering from severe anemia, active pulmonary tuberculosis, epilepsy, organic diseases of the nervous system, should not be allowed to work where the possibility of carbon monoxide inhalation is possible.

Benzene C 6 H 6 is a liquid with an aromatic odor. Boiling point 79.6 ° C. Evaporates at room temperature. Benzene vapor is 3 times heavier than air.

Benzene is used in industry as a solvent for fats, varnishes, paints, and rubber. It is used to obtain nitrobenzene, aniline, fat extraction, etc. It occurs in the process of obtaining it from coal and oil, as well as in the chemical and pharmaceutical industries.

Benzene enters the body in the form of vapors through the respiratory organs and, as a fat solvent, can penetrate the skin. Excreted from the body through the lungs, partly through the kidneys.

In acute poisoning, which is rare under industrial conditions, dizziness, headache, agitation, followed by drowsiness, are observed. In severe cases, muscle

Sharp changes in white blood are noted. Initially, leukocytosis is observed, followed by leukopenia. A decrease in the number of leukocytes to 4-10 3 and lower numbers is considered one of the early signs of poisoning. Changes are also observed in red blood. The amount of hemoglobin and red blood cells decreases sharply, blood clotting decreases. In chronic intoxication, there is a decrease in the immunobiological resistance of the organism.

Prevention. Replacing benzene with less toxic solvents, such as toluene, ethyl alcohol. Sealing of production processes, local and general ventilation.

Severe anemia, impaired liver and kidney function, diseases of the nervous system, persistent dermatitis and eczema are a contraindication to working with benzene.

Chemical substances are called carcinogenic, which, acting on the body, lead to the occurrence of malignant neoplasms.

As occupational carcinogens are known:

isopropyl oil.

The incidence of occupational cancer has recently been growing due to the introduction of a large number of new carcinogens into industry and agriculture. In the USA in 1952, 500 cases of occupational cancer were registered per 100,000 workers, compared with 98 cases in 1928.

twitching, loss of consciousness. The pulse is frequent and small, arterial pressure is lowered.

In chronic poisoning, benzene affects nerve cells rich in lipoids, as well as hematopoietic organs and blood vessels. Due to a violation of the permeability of the vascular wall, bleeding develops from the gums, nose, etc.

Sharp changes in white blood are noted. Initially, leukocytosis is observed, followed by leukopenia. A decrease in the number of leukocytes to 4 10 3 and lower numbers is considered one of the early signs of poisoning. Changes are also observed in red blood. The amount of hemoglobin and red blood cells decreases sharply, blood clotting decreases. In chronic intoxication, there is a decrease in the immunobiological resistance of the organism.

With prolonged contact of the skin with benzene, small vesicular rashes, redness, and itching may develop. Women may experience menstrual disorders.

Prevention. Replacing benzene with less toxic solvents, such as toluene, ethyl alcohol. Sealing of production processes, local and general ventilation.

Severe anemia, liver and kidney dysfunction, diseases of the nervous system, persistent dermatitis and eczema are a contraindication to working with benzene.

The maximum allowable concentration of benzene is 5 mg/m 3 .

Carcinogenic substances in industry

Chemical substances are called carcinogenic, which, acting on the body, lead to the occurrence of malignant neoplasms.

As occupational carcinogens are known:

products of distillation and fractionation of coal, including tar, pitch, creosote, anthracene oil, etc.;

products of distillation and fractionation of shale, charcoal, oil, tar, asphalt, crude wax;

aromatic amines, nitro and azo compounds;

some products of the processing of chromium and nickel ores;

inorganic arsenic compounds;

isopropyl oil.

In recent years, the blastomogenic effect of beryllium compounds has been experimentally established.

The blastomogenic effect of carcinogens can occur with irregular contact with them and after a long time after contact has ceased.

Occupational skin cancer is localized on exposed parts of the body and occurs as a result of exposure to chemicals and physical factors, mostly radiant energy. There are cases of occupational cancer from coal tar (tar cancer), pitch (pitch cancer), paraffin, almond oils.

Skin cancer is found in doctors, x-ray technicians. Mainly the hands are affected. The development of cancer is preceded by precancerous conditions, chronic dermatitis, papillomas.

Occupational lung cancer occurs in contact with distillation products of shale, coal, oil, compounds of chromium, nickel, arsenic, etc.

Occupational bladder cancer is attributed to the action of aniline fumes.

Prevention. To prevent occupational cancer, it is necessary to remove substances that are highly carcinogenic from production.

Soviet legislation prohibits the production of 2-naphthylamine, benzidine, 2,3-dichlorobenzidine and 4-aminodiphenyl. The use of pitch as a road surface is prohibited.

An important preventive measure is the development and implementation of technological processes that are accompanied by a slight release of carcinogens.

Sealing production processes, dust control, the use of protective clothing, and personal hygiene practices prevent occupational cancer. Persons in contact with carcinogenic substances should undergo medical examination

training, periodic medical examinations, be aware of the measures to protect against the action of carcinogens. Workers who show symptoms of precancerous diseases should be rehabilitated and transferred to another job.

From the air, mercury vapor is absorbed in the lungs by 85-90%. Erosion particles containing mercury salts settle in the respiratory tract, dissolve in their discharge, and are partially swallowed, entering the stomach. In the form of mercury albuminates from the lungs and gastrointestinal tract, mercury is carried by the blood throughout the body, accumulating in organs with a high blood supply - the kidneys, liver, thyroid gland, and brain. The distribution of this liquid metal in the body is determined by the nature of the mercury compound and the route of its intake. When poisoning with mercury vapor, its maximum accumulation is noted in the lungs, brain, kidneys, liver and heart. In people living in areas of atmospheric mercury pollution, there is a predominance of diseases of the respiratory system, nervous system, sensory organs, blood circulation, genitourinary, endocrine systems, eating disorders and metabolic disorders.

The penetration of mercury ions into the cell is preceded by damage to the cell membrane as a result of interaction with sulfhydryl groups of proteins, which is accompanied by a violation of its structure. Having penetrated inside the cell, mercury accumulates in the nucleus, microsomes, cytoplasm, mitochondria, excluding reactions with sulfhydryl, carboxyl amino groups from biochemical processes. Protein, nucleic, energy metabolism, stability of tissue lipoprotein complexes are violated. The high affinity of mercury for nucleic acids, especially transfer RNA, is accompanied by a pronounced gonado- and embryotoxic effect.

The clinical picture of intoxication depends on the form of the mercury compound, the ways it enters the body, and the volume of the poison that has stuck in.

Acute poisoning of people with mercury vapor occurs during accidents, fires in mercury mines and factories, or as a result of gross violations of safety regulations. The clinical picture of inhalation poisoning develops after 8-24 hours and includes general weakness, headache, pain when swallowing, fever, catarrhal phenomena from the respiratory tract (rhinitis, pharyngitis, less often bronchitis). Then the hemorrhagic syndrome joins, soreness of the gums, pronounced inflammatory changes in the oral cavity (the so-called mercury stomatitis with an ulcerative process on the mucous membrane of the gums), abdominal pain, gastric disorders, signs of kidney damage appear.

In children, a few hours after the start of inhalation of mercury vapor, severe pneumonia can develop - cough, shortness of breath, cyanosis, and fever appear. In severe intoxication, pulmonary edema is possible. At the same time, there are symptoms of damage to the gastrointestinal tract (frequent loose stools) and the central nervous system (drowsiness, followed by periods of increased excitability).

In the gastrointestinal tract, 10-30% of water-soluble inorganic mercury compounds and up to 75% of organic compounds can be absorbed, while metallic mercury is very poorly absorbed (about 0.01%). At the same time, organic mercury compounds, due to their high lipoidotropy, easily penetrate into tissues through histohematic barriers, including through the blood-brain barrier in the central nervous system, as well as through the placental barrier into the fetus.

Acute poisoning with inorganic mercury compounds (dichloride, cyanide, mercury nitrate) occurs when they are mistakenly ingested or used for suicidal purposes. Mercury dichloride (mercuric chloride) is the most toxic. The lethal dose of sublimate is 0.5 g. The intake is accompanied by burning pain in the mouth, pharynx, esophagus, in the stomach, along the colon. There is a headache, profuse salivation, bad breath, redness and bleeding of the gums, stomatitis, necrotic deposits on the mucous membrane of the tongue, throat and pharynx. Possible swelling of the larynx. Dyspeptic phenomena are observed - nausea, prolonged, persistent vomiting, diarrhea with mucus and blood, tenesmus, multiple manifestations along the mucous membrane of the stomach and duodenum. Body temperature often rises. In severe cases, necrotizing nephrosis develops. Polyuria is replaced by progressive oliguria. Albuminuria and hematuria are observed. Damage to the kidneys with sublimate is manifested by continuous necrosis of the epithelium of the convoluted tubules. The early onset of anuria is regarded as an unfavorable sign of the development of the sublimate kidney syndrome, leading to death on the 5-6th day. In relatively mild cases of poisoning, impaired functions are restored after 2-3 weeks.

Sodium chloride, acids, alcohol and fats increase the solubility of sublimate. The intake of salty, fatty, acidic foods and alcohol in this poisoning is contraindicated, nicotine poisoning sharply aggravates.

In chronic intoxication with mercury vapor, the development of the clinical picture is determined by the intensity of exposure and the individual characteristics of the organism. In general, chronic intoxications develop gradually and do not have obvious signs of the disease for a long time. The initial stage proceeds according to the type of neurasthenia and vegetative-vascular dystonia. In the expressed stage the psychoneurotic syndrome is noted. The transitional state from the compensatory phase to the initial stage of mercury poisoning is called "micromercurialism". A strict distinction between the stages of the disease is difficult, since as the severity of the symptoms of intoxication increases, they gradually pass into one another. Of great importance in this sense is the transition from the small-scale and asymmetric tremor of the fingers of outstretched hands in the initial phase of mercurialism to the large-scale tremor of the hands, characteristic of the pronounced stage of chronic poisoning. This stage is characterized by emotional incontinence, explosiveness, hypothalamic dysfunction, vagotonic reactions and visceroneurotic manifestations (pain in the heart, palpitations, intestinal dyskinesia, bladder, gastritis). In the stage of pronounced manifestations of intoxication, individual signs of encephalopathy are possible.

The first manifestations of mercurialism - increased fatigue, weakness, drowsiness, apathy, headaches, dizziness, bleeding gums - fit into the picture of "mercury neurasthenia". Over time, tremor develops ("mercury tremor"), first of the fingers of outstretched hands, then of the tongue, eyelids, and in severe forms - of the legs and the whole body. There is a state of increased mental excitability ("mercury erethism"), combined with rapid exhaustion of the nervous system and the appearance of timidity, fearfulness, general depression, self-doubt. With the progression of the disease, patients are extremely irritable, gloomy, and often cry. Night sleep is disturbing, and during the day they are drowsy, memory and attention are often weakened. Hypersalivation observed in mercurialism, impaired secretory function of the stomach, cyanosis, sweating, slow or rapid heartbeat, and increased urge to urinate are associated with the effects of mercury on the autonomic nervous system. In the initial stage, there are signs of increased excitability of her sympathetic department. This is manifested by tachycardia, bright red blurred dermographism and is combined with hyperthyroidism.

The defeat of the peripheral nervous system proceeds according to the type of multiple neuralgia. Neurotic manifestations are characterized by pain in the limbs and in the area of the trigeminal nerve, mild sensitivity disorders of the distal type. Facial asymmetry may be observed. One of the important signs is the weakening of the extensor strength on the predominantly working arm. Changes in the digestive organs are weak or completely absent, as are changes in the kidneys.

It has been established that non-specific manifestations of long-term mercury intoxication may be observed in persons suffering from mercurialism. Thus, the phenomena of atherosclerosis, coronary disorders, liver and gallbladder damage are diagnosed 5-7 times more often in those who have manifestations of mercurialism than in those who do not have mercury intoxication.

When diagnosing micromercurialism, certain difficulties arise. Many of its cases pass under the guise of respiratory diseases, often diagnosed as neurasthenia, hysteria, etc.

Recently, the symptoms of micromercurialism are often detected in workers in production, employees of research institutes, working under conditions of exposure to low concentrations of mercury (at the MPC level or several times higher than 0.01 mg/m3) for at least 8-10 years. In this case, the main manifestations of the disease are expressed in changes in the central nervous system.

Almost always there is a characteristic small and frequent tremor of the fingers of outstretched hands, bleeding gums, hypersalivation, gingivitis. On the part of the blood - a decrease in hemoglobin and the number of erythrocytes, leukopenia, a shift in the leukocyte formula to the left.

With micromercurialism caused by mercury, its inorganic compounds or organomercury compounds, there are no clear clinical differences in the symptoms of intoxication.

Treatment of mercury poisoning is a complex of specific pathogenetic, symptomatic, restorative physiotherapy.

The most radical and active way to treat poisoning with mercury salts is extracorporeal detoxification - hemosorption, lymphosorption, hemodialysis, peritoneal dialysis.

Dithiol compounds, in particular unithiol, have an antidote effect. Apply in the form of 5 percent. solution subcutaneously or intravenously at the rate of 50 mg for every 10 kg of the patient's weight. On the first day, 3-4 injections are made every 6-8 hours, on the second day - 2-3 injections, on the next 3-7 days - 1-2 injections, depending on the patient's condition. In chronic mercury intoxication, treatment with unithiol aerosol inhalations is effective. Highly dispersed aerosol 5 percent. unitiol solution, patients inhale 2 times a day, 15 ml. To eliminate the smell of hydrogen sulfide characteristic of unithiol, 1-2 drops of menthol oil are added to it before inhalation. The treatment lasts 10 days, repeated courses are recommended. On an outpatient basis, you can use calcium-disodium salt of EDTA, 0.5 g 3 times a day for 4 days, in the form of 2 courses with a week break.

For the treatment of subacute intoxication and as a means of individual prevention, succimer is used, which successfully combines the complexing action of dithiol with succinic acid.

In acute mercury poisoning, especially when its dissociating salts (mercury dioxide, mercury oxycyanide, mercury nitrate) enter the stomach, simultaneously with the introduction of unitiol, an antidote of metals (Strzhizhevsky) is given. Hydrogen sulfide, which is part of the antidote, converts mercury compounds into insoluble sulfides that are excreted in the feces. 100 ml of this antidote will neutralize up to 4 g of sublimate. Before taking the antidote, give 200-300 g of water acidified with vinegar or citric acid to drink. After 10 minutes, the stomach is washed through the probe with slightly acidified water, to which 100 ml of the same antidote can be added, until clear water appears. After washing through the tube, a laxative is introduced. In the absence of an antidote, immediately rinse the stomach with plenty of water with 20-30 g of activated charcoal or protein water (2 beaten egg whites per 1 liter of water), then give milk, beaten egg yolk with water, and then a laxative, rinse your mouth 5 percent . potassium permanganate solution or Berthollet salt solution.

High siphon enemas with activated charcoal suspension and tannin are shown.

Simultaneously with the above measures of detoxification, the fight against acute renal failure begins. Diuresis is forced by intravenous administration of an isotonic solution of sodium chloride, polyglucin, 5 percent. glucose solution, drip up to 4-5.5 liters per day, with diuretics (lasix up to 200 mg per day). Protein hydrolysates, colloidal suspensions, blood substitutes are introduced in large volumes. If necessary, bilateral pararenal novocaine blockades, diathermy of the kidney area, and surgical decapsulation of the kidneys are carried out.

Along with specific antidote therapy, general strengthening and toning the nervous and cardiovascular systems are widely used - strophanthin or corglicon, caffeine, cordiamin, mezaton, with collapse - norepinephrine in 5 percent. glucose solution intravenously, drip. Complex vitamin therapy, adaptogens, antihistamines are shown.

Physiotherapeutic methods of treatment are recommended: hydrogen sulfide baths, galvanic baths with sodium hyposulfite or sulfur, ultraviolet irradiation in combination with warm pine baths. It is advisable to treat at the resort (Matsesta, Pyatigorsk, etc.) with sulfuric and hydrogen sulfide baths. It is recommended to include lipotropic substances and pectins in the diet.

The terms of treatment and rehabilitation of patients with both acute and chronic poisoning are delayed for a long time. This is due to the fact that mercury compounds are slowly excreted from the body. Thus, the half-life of methylmercury averages 75 days, and inorganic compounds - 42 days. Patients with chronic mercury intoxication of the first stage need inpatient treatment for an average of 2-3 weeks. After an additional, up to 2 months, stay on sick leave, it is allowed to start work with careful dispensary observation. If there are symptoms of asthenia, work with mercury is contraindicated.

The following interpretation of the results of analyzes of biosubstrates for mercury content was adopted. In the blood, the norm of mercury content is in the range of 0.3-0.7 μg%, the content above 1 μg% is considered elevated. The permissible level of mercury in the urine during occupational exposure to its vapors is 10 µg/l. Normal excretion of mercury in the urine can reach 5-7 mcg/day. In hair, the upper limit of safe mercury content is 5 µg/g.

Among the organizational activities carried out by the sanitary and epidemiological service in all cases of mercury pollution, one should single out the establishment of the boundaries of the source and levels of pollution, the assessment of possible consequences for public health when staying in a polluted atmosphere, the decision on the need for medical examination and observation of victims, the determination of the scope of the safe regime work of personnel conducting demercurization, assessment of the effectiveness and sufficiency of demercurization and the possibility of further operation of contaminated facilities.

The assessment of the health risk of persons who were in the source of mercury pollution is determined by the average daily concentration of mercury vapor in the inhaled air and its comparison with the MPC (for atmospheric air, the average daily MPC = 0.0003 mg/m3).

Clinical examination of the population and determination of the mercury content in the biospheres (blood, urine, hair) are recommended if the concentration of mercury vapor for the working area is within 0.01-0.02 mg/m3, and for atmospheric air - about 0.003-0.005 mg/m3 with the duration of such exposure for several weeks or months. At lower concentrations or a shorter exposure, clinical examination of pregnant women, as well as children (if parents apply), can be limited.

Premises are considered contaminated if the content of mercury vapor in the air exceeds the established hygienic standards (MPC for air in residential premises, schools, preschool institutions and public buildings - 0.0003 mg/m3). Contaminated premises are subject to demercurization, that is, a set of measures to remove mercury by various methods: mechanical (collection, sorption, wet mechanical cleaning, removal of contaminated structures, etc.), physical (calcination, forced ventilation with hot air), chemical (transfer of mercury into bound state to reduce the rate of evaporation).

Andrey PODLESNII, Associate Professor,

Viktor ANIKEENKO, senior lecturer.

Department of Disaster Medicine and Civil Defense Medical Service of the Russian State Medical University.

Vladimir KIRYANOV, Deputy Head of the Department of Toxicology and Medical Protection.

Moscow Medical Academy. THEM. Sechenov.

Pathogenesis. Mercury belongs to the group of thiol poisons. Once in the body, in particular in the bloodstream, mercury combines with proteins and circulates in the form of albuminates. mercury disrupts protein metabolism and the course of enzymatic processes. All this leads to profound dysfunction of the central nervous system, especially its higher divisions. Mercury is the source of impulses entering the cerebral cortex. As a result, a number of reflex disorders occur in the cortical-subcortical regions.

The formation of the pathological process during mercury intoxication occurs in phases and is characterized by a complex of neuro-regulatory and neurohumoral changes. In the initial period and further, as the pathology develops, when adaptive-protective mechanisms cannot block the action of a toxic agent, disturbances develop in the autonomic parts of the CNS. At the same time, in accordance with the functional state of the cerebral cortex, the excitability of analyzers (olfactory, visual, gustatory) changes. In the future, the exhaustibility of cortical cells increases, disinhibition of the subcortical and, first of all, the hypothalamic sections is revealed. All this leads to a weakening of internal active inhibition and inertness of cortical processes. As a result, the symptoms of “mercury neurosis” corresponding to the clinical picture of mercury intoxication develop, as well as disturbances in the cardiovascular system, digestive tract and metabolic processes. As intoxication increases, disturbances in the neurodynamic relationships between the cortex and the thalamus, as well as between various structures of the motor analyzer, including the subcortical ganglia and the cerebellum, are revealed.

Mercury can attack the nerve-to-muscle transmission apparatus in the motor nerves, causing disturbances in the extrapyramidal system as a whole. All this leads to disorders of complex functional connections that control the automatism of the combined activity of various muscle groups.

The main route of entry into the human body is inhalation. Mercury absorbed into the blood of the pulmonary capillaries circulates for some time in the form of mercury albuminates. Then it is deposited for a long time in the liver, kidneys, spleen. Overcoming the blood-brain barrier, it finds itself in the cerebrospinal fluid and brain, where it directly affects the cerebral cortex and the thalamo-hypothalamic region. Violation of the connections of the cortex with the thalamus and hypothalamus is accompanied by a breakdown in the mechanism of formation of emotional reactions. In addition, the accumulation of mercury is accompanied by inhibition of sulfur-containing enzymes, because. it forms complexes with sulfhydryl groups, exerting a blocking effect on them.

Clinical picture of acute and chronic mercury intoxication

Acute intoxication under production conditions, it is rarely observed (in emergency cases, when cleaning mercury boilers and furnaces), develops within 1-2 hours after inhalation of high concentrations of mercury vapor and manifests itself in mild cases, mainly by neuropsychiatric symptoms (general malaise, weakness, headache, irritability, insomnia, irritability), as well as an increase in body temperature, the appearance of a metallic taste in the mouth, salivation, diarrhea, vomiting, stomatitis and signs of bronchitis and the gastrointestinal tract. In more severe cases of intoxication, ulcerative stomatitis, hemorrhagic enterocolitis, toxic pneumonia, hepatitis and nephropathy develop.

Chronic intoxication vapors of metallic mercury in the clinic of occupational diseases is of primary importance and occurs in workers who have been in contact with mercury for a long time. The clinical symptoms of intoxication develop gradually and are manifested mainly by non-specific damage to the nervous system, which greatly complicates the diagnosis of early forms of chronic mercury intoxication, which may explain the insufficient detection of this occupational pathology.

The nervous system is early involved in the pathological process of exposure to mercury on the body and is clinically manifested mainly by functional disorders of the nervous system according to the type of varying severity of astheno-vegetative syndrome (AVS), which at a later stage of development of intoxication can develop into an organic pathology (encephalopathy).

Light ABC characterized by astheno-neurotic complaints (mainly of a hypersthenic nature) and vegetative-vascular dysfunction with sympathetic-tonic orientation of vegetative-vascular reactions. The main complaints are headache, fatigue, superficial sleep at night and noticeable drowsiness during the day at work, slight memory loss and tearfulness, irritability. hypertension, negative perverted Ashner-Danini reflex, tremor of the fingers of outstretched hands, small-amplitude and inconsistent, detected more often only with excitement.

Moderate ABC - characterized by a significant increase in the severity of all the above symptoms with a predominance of irritable weakness and more pronounced sympathetic-tonic disorders: persistent headache, dizziness, insomnia, increased irritability, tearfulness and emotional instability, excitability, timidity, inadequate embarrassment, self-doubt at work, especially in the presence of strangers, while due to strong excitement there is a pronounced vascular reaction with increased heart rate, reddening of the face and general hyperhidrosis, which indicates the development of the so-called "mercury erethism". The tremor intensifies, which acquires a permanent character against the background of developing intentional trembling of the fingers, which makes it difficult to perform small work.

Pronounced ABC - characterized by an increase in asthenia with an increase in the parasympathetic orientation of vegetative-vascular disorders with paroxysms (half-faint, pain in the heart, general hyperhidrosis, cold extremities, pallor of the skin and a pronounced emotional reaction): constant headache, severe irritability, tearfulness, a tendency to depression , decreased range of interests, mood changes, hypochondriacal reactions, general weakness, apathy, a tendency to bradycardia and hypotension, a decrease in skin temperature on the fingers with a positive cold test, a decrease in muscle strength in the hands with a positive test for fatigue and muscle tone of the flexors and extensors of the hand . The tremor becomes large - sweeping, tends to generalize and spread to the legs, head, intentional trembling intensifies. Microorganic symptoms appear: anisocoria, weakness of the internal muscles of the eyes during convergence, nasolabial asymmetry, slight deviation of the tongue, mild anisoreflexia, nystagmoid.

Along with neurological symptoms in chronic mercury intoxication, changes in other organs and body systems can also be detected: loosening and bleeding of the gums, gingivitis, stomatitis, periodontal disease, hair loss, brittle nails, hyperfunction of the thyroid gland, impotence, there is a violation of carbohydrate, protein and enzymatic functions. liver, kidney irritation phenomenon. Functional disorders of the cardiovascular system are possible, occurring in the form of neurocirculatory dystonia (on the ECG, a decrease in the voltage of the T wave, the QRS complex, signs of incomplete blockade of the His bundle and left ventricular hypertrophy, slowing of intra-atrial conduction), intestinal dyskinesia, gastritis. In some cases, there may be violations of thermoregulation, manifested by persistent subfebrile condition; on the part of the blood - lymphocytosis and monocytosis, less often anemia and leukopenia, a decrease in the content of sulfhydryl groups.

Early diagnosis chronic mercury intoxication is based mainly on clinical data, taking into account the specific working conditions of the sick person, anamnesis, and the dynamics of the disease. Confirmation of the diagnosis of intoxication can be the presence of mercury in the biospheres - urine, blood, and hair.

The excretion of mercury with urine indicates its circulation in the body and the presence of a mercury depot (mainly the liver, kidneys, spleen, brain); blood mercury reflects recent exposure, while hair mercury reflects chronic exposure and may reflect the development of risk of toxicity.

Depending on the severity of neurological manifestations, the following 3 stages of development of chronic mercury intoxication are distinguished:

1 stage of intoxication(initial or mild degree) - functional (“micromercurialism”) stage and is characterized by mild astheno-vegetative syndrome with small-amplitude tremor and mercury content in urine from 150 to 300 μg / l; in the blood 7.5-15.0 µg% and in the hair 2-8 mg/kg.

Stage 2 intoxication(moderate degree) - characterized by the progression of functional disorders of the nervous system, the appearance of microfocal symptoms and is manifested by a moderately pronounced astheno-vegetative syndrome with a possible transition to encephalopathy and large-scale intentional tremor, as well as initial polyneuropathy; the content of mercury in the urine is 300-600 µg/l, in the blood - 15.0-30.0 µg%, in the hair 8-30 mg/kg.

III stage of intoxication(pronounced degree) - rare, organic neurological symptoms appear against the background of a pronounced astheno-vegetative syndrome - encephalopathy (asthenoorganic, astheno-depressive and hypothalamic syndromes) with a significant large-scale and intentional tremor with a tendency to generalization, polyneuropathy; the content of mercury in the urine is 600 µg/l or more, in the blood - 30.0 µg% or more, in the hair - 30 mg/kg or more.

Treatment. The main task is the mobilization of mercury compounds from the depot, neutralization and rapid elimination from the body. The antidote is unithiol, which is administered intramuscularly in the form of a 5% solution of 5.0 every 8-12 hours in the first three days after poisoning, in the following days - 1 time per day for two weeks. Unithiol inhalations are used. The elimination of mercury from the body can also be enhanced by sodium thiosulfate with the on / in the introduction of a 30% solution of 20.0; D-penicillamine 0.15x3 times.

The main therapeutic measures should be aimed at removing mercury from the body, general detoxification, symptomatic and restorative therapy. To bind and remove mercury from the body, intravenous infusions of a 30% solution (20 ml) of sodium hyposulfite are used, for a course of 15-20 infusions or a 5% solution of unitiol, 5 ml intramuscularly, as well as ingestion of succimer 0.5 three times a day or cuprenil at an average dose of up to 600 mg per day for 5-10 days, always under the control of a urine test for mercury content; shows oral sulfate - ion in the form of an aqueous solution of sodium sulfate at the rate of 25 mg per kg of body weight (usually an aqueous solution of sodium sulfate is given 1.4-2.1 g per 200.0 once a day for 1-1.5 hours before meals, a course of at least one month), methionine or cestein, and hydrogen sulfide baths are also recommended.

Drug therapy with a predominant lesion of the nervous system should be aimed primarily at the normalization of cortical - subcortical neurodynamic disorders, taking into account vegetative - vascular disorders (sympathetic or parasympathetic orientation of the reaction): valerian, motherwort, meprotan, amizin, finozepam, pyrroxane, anaprilin; with encephalopathy - aminalon, riboxin, stugeron; in the presence of polyneuropathy - B vitamins, dibazol, biostimulants, physiotherapy and reflexology are also indicated. Symptomatic therapy is also carried out, taking into account those available from other organs and systems of the body, while observing a strictly differentiated and individual approach.

Prevention. Improvement of technological equipment, automation and mechanization of the main production processes, maximum sealing of equipment. Functioning of general and local ventilation. Automatic methods of controlling the air pollution of the workshop and personal protective equipment for workers should be introduced. Particular attention should be paid to the improvement of overalls, special footwear and methods of their disposal. Cleaning and neutralization of the surface of equipment, walls, floors. Regular cleaning of the premises and periodic demercurization with a 20% solution of iron trichloride or potassium permanganate. Spilled mercury must be carefully collected. All work with open mercury, its heating should be carried out in fume hoods.

Prohibition of eating and smoking in the workshop. Anti-alcohol propaganda. Compliance with the regime of work and rest. Sanitation of the oral cavity. Organization of preventive nutrition, which provides for a sufficient content of vitamins, juices, fresh vegetables. During operation, use mineral waters containing sulfates. Preliminary and Periodic Inspections

Additional medical contraindications for employment in contact with mercury and its compounds are:

chronic diseases of the peripheral nervous system;

drug addiction, substance abuse, including chronic alcoholism;

severe autonomic dysfunction;

diseases of the teeth and jaws (chronic gingivitis, stomatitis, periodontitis, periodontal disease);

pronounced, often aggravated forms of chronic gastritis;

chronic, often recurrent skin diseases;

schizophrenia and other endogenous psychoses.

Medico-social examination, labor rehabilitation and clinical examination.

Expert tactics in relation to patients with chronic mercury intoxication should be determined taking into account the characteristics of the clinical development and course of the disease, its severity, the presence of concomitant diseases, as well as taking into account specific sanitary and hygienic working conditions at the workplace. At stage 1 of the disease (mild degree of intoxication), only a temporary suspension from work in contact with mercury vapor is recommended, no more than two months, preferably with the subsequent addition of a labor leave. In the event that the treatment and temporary suspension from the main work has a reverse development of the manifestations of intoxication, it is possible for the employee to return to his previous job, subject to dispensary observation and favorable sanitary and hygienic working conditions, i.e. return to the previous job should be carried out very carefully.

In case of recurrence of intoxication after returning to the previous job, as well as in cases where all therapeutic and preventive measures do not eliminate the clinical manifestations of intoxication, it is necessary to refer the patient to MSEC to determine the degree of disability due to an occupational disease, if the employee's qualifications are reduced. Employment without contact with any toxic substances.

At 2 (moderate degree of intoxication) and especially III (pronounced degree of intoxication) stages of chronic mercury intoxication, contact with mercury should be completely stopped. Patients are rationally employed through MSEC and a disability group is established for an occupational disease due to persistent disability in most cases in the presence of severe forms of encephalopathy.

Block 3.

Patient P., aged 42, works in the production of batteries. He was taken to the hospital by ambulance due to severe abdominal pain. From the anamnesis, it was found out that even before working at the battery plant, he suffered from duodenal ulcer. Over the next 20 years, there were no exacerbations, which was also confirmed by gastric studies ...

Diagnosis: Chronic lead intoxication, severe form. The diagnosis was made on the basis of data on the patient's place of work, patient complaints, blood test data

Additional studies: conduct a sanitary and epidemiological examination of the place of work on the lead MPC, conduct a urinalysis, diagnose the nervous system for the presence of neurological syndromes

Treatment: Complex therapy in the form of 3 cycles of intravenous administration of 20 ml of 10% tetacin-calcium solution. It is possible to add D-PAM in the subsequent dose of 600-900 mg per day under the control of blood, indicators of porphyrin metabolism. Treatment in stationary conditions.

Option 5

Block 1

2) reticulocytes

5)Ability to penetrate intact skin

6) markans, parksineon

7) in the bones

8) red

9) asthenovegetative

Block 2

Intoxication with these drugs is possible when used in agriculture and industry, when eating pickled grain.

Clinic. Chronic poisoning develops after a more or less long latent period (average 2 months). The first signs of the disease are manifested in the form of nausea, vomiting, trophic lesions of the oral cavity (the gums are loosened, bleed, salivation increases sharply, and gingivitis-stomatitis often develops). A frequent symptom of the disease is polydipsia (excessive thirst) and polyuria. Patients drink 2-6 liters of fluid per day and excrete the same amount of urine. The Zimnitsky test reveals isostenuria in these patients. Some patients complain of pollakiuria and pain when urinating. Almost half of the patients have irritation of the urinary tract: macroalbuminuria, the presence of leukocytes in the urine, microhematuria. In severe cases, reverse phenomena are possible - oliguria, azotemia. Possible death from uremia.

Pathogenesis. The mercury compounds contained in the air enter the respiratory tract, are absorbed into the blood and circulate in the body. Then they are quickly adsorbed and linger in them for a long time. The greatest amount of mercury accumulates in the liver, kidneys, brain, in smaller quantities it is contained in the spleen, lungs, heart. There is a violation of carbohydrate, protein and fat metabolism. Thus, mercury compounds can interfere with the tissue metabolism of vital organs. Treatment. The main task of treatment is the mobilization of mercury compounds from the depot, neutralization and rapid elimination from the body.
The successful solution of this problem is facilitated by the use of unitiol. The drug is administered to patients intramuscularly in the form of a 5% solution. Unithiolo inhalations are also used. Vitamin therapy is indicated - C and group B. With stomatitis - rinsing with 0.25% solution of potassium permanganate or 35 boric acid. Patients with chronic mercurialism are shown sanatorium-and-spa treatment. If the drug is ingested, it is necessary to wash the stomach with a weak solution of potassium permanganate and give an adsorbent - activated carbon or "protein water" (2 egg whites per glass of water) and a laxative.

Block 3

Chronic intoxication with fluorine.

At the initial stage of intoxication, a transfer to another temporary job and appropriate treatment are recommended. With persistent symptoms of hepatitis, polyneuritis, as well as stage II bone fluorosis, the severity of other lesions of the musculoskeletal system with persistent pain and dysfunction, further work with fluorides is contraindicated. Women during pregnancy and lactation should be excluded from working with fluorides.

Option number 6

1. Indicate the distinctive feature of mercury during its evaporation: colorless

2. Amino and nitro compounds of benzene do not include: styrene

3. Where should white phosphorus be stored: under water

4. The most dangerous way for lead to enter: respiratory system

5. Preventive measures for pesticide intoxication: replacing hazardous pesticides with less hazardous ones

6. Pneumocaniosis developing when working with manganese: manganocanioses

7. What form of lead polyneuritis is the development of paresis and paralysis: motor

8. How the skin is treated when phosphorus enters: 5% copper sulfate solution

9. Norm of methemoglobin in erythrocytes: no more than 1.0-2.5%

10. In case of poisoning with carbonates, the symptoms of the lesion come to the fore: skin and mucous

Mercury poisoning is one of the severe variants of intoxication of the human body, which leaves behind a number of negative consequences. This condition is feared by children and adults, especially panicking in cases where a mercury thermometer breaks. This article will present data regarding the clinical signs of acute or chronic mercury poisoning and under what circumstances this may occur.

Characteristics of mercury

Mercury is a substance of the first hazard class. It is a transition metal that is a silvery white liquid. Vapors of this substance are especially poisonous (at the usual temperature of the living room).

Metallic mercury is not capable of exerting a toxic effect on the body, but its pores and soluble compounds are very toxic and belong to the category of cumulative poisons.

Even in small amounts, mercury can cause serious health problems. The toxic effect is on the immune, nervous, digestive systems, eyes, skin, lungs, liver, kidneys. Therefore, in the case of mercury poisoning, the clinical picture is associated with a violation of the functions of these systems and organs.

Despite this, mercury continues to be widely used in manufacturing and industry. The most common mercury object is a mercury thermometer with a silvery core, which is used to measure body temperature.

Poisoning resulting from breaking a household thermometer is extremely rare and can occur in those families that completely disregard safety rules or often break thermometers without subsequent demercurization of the premises. In case of mercury poisoning due to damage to the thermometer, the symptoms in most cases will be chronic.

Acute mercury poisoning is possible if a large number of energy-saving lamps are broken.

Where in everyday life can a person encounter mercury?

Despite the danger of this metal, it is not so easy to meet with mercury in ordinary life, especially in such quantities that it develops into a serious pathology.

Mercury is used in the energy sector in the production of mercury galvanic batteries, in metallurgy for the production of various alloys, in the processing of recyclable materials from aluminum, in the chemical industry as one of the reagents, in agriculture for pickling pesticides - in such cases, mercury poisoning is possible in the process of professional activities and is characteristic of people of certain professions.

Previously, silver amalgam was used in dental practice, but the invention of photographic materials excluded this material from use. One filling can contain up to several hundred mg of this metal.

Mercury vapor is contained in fluorescent lamps, vapors are capable of glowing in a glow discharge. Mercury content - up to 70 mg.

Metallic mercury is used in medicine as a filling material for thermometers. This is due to the fact that the metal has a high thermal conductivity, does not wet the glass and gives accurate measurement data. The thermometer contains about 2 gr. mercury.

Elemental mercury, as well as mercury compounds, can accumulate in seafood, thus reaching hundreds of times the element in water. At the same time, seafood processing technology does not reduce the metal content in the final product.

Therefore, in order to poison yourself with mercury, you need to try and find it. This, unfortunately, is what inquisitive people do, who bring home unknown devices and devices and disassemble them, not even suspecting that they can be a source of mercury evaporation.

Sometimes, in particularly extreme cases, chronic mercury poisoning is diagnosed in people who purchased housing on the secondary market, in the cracks and under the floors of which mercury was inexplicably present.

With all this, you need to be especially vigilant when a mercury lamp or a thermometer breaks, you need to follow a number of simple steps that will protect your loved ones, you and your pets from intoxication with mercury vapor.

Specific effects of mercury vapor on the human body

Inhalation of air, which contains mercury vapor in a total concentration of 0.25 mg/m 3 , leads to metal accumulation in the tissues of the lungs. At higher concentrations, mercury can be absorbed through the skin. Depending on the duration of mercury ingestion and the amount of ingested material, chronic or acute poisoning develops. Micromercurialism belongs to a separate category.

Symptoms of mercury intoxication

Acute poisoning

The first symptoms are noted a couple of hours after direct contact with the metal:

headache;

general weakness;

metallic taste;

pain when trying to swallow something;

lack of appetite;

swelling and bleeding of the gums;

salivation.

A little later there is:

mucous diarrhea with blood and severe pain in the abdomen;

shortness of breath and cough - the addition of inflammation of the lung tissues, severe chills, chest pain, catarrh of the respiratory tract;

hyperemia is also characteristic with an increase in temperature up to 38-40 degrees;

mercury may be present in the urine (determined during the study).

The symptoms of mercury intoxication are the same for adults and children. The only difference is that the child may develop symptoms more quickly, the clinical picture will be brighter, and help will be needed immediately.

Chronic intoxication

Mercurialism is a general poisoning resulting from chronic exposure to mercury compounds and vapors that far exceed the allowable limits for two to five months or years. Manifestations depend on the state of the nervous system and the body:

dizziness;

general weakness;

causeless drowsiness;

increased fatigue;

emotional disorders: irritability, depression, shyness, self-doubt;

There is a weakening of memory, loss of self-control and decreased attention. Gradually, a vivid symptom of intoxication begins to appear - “mercury tremor”, which is characterized by trembling of the eyelids, lips, legs and hands, which occurs during excitement. There are urges to urinate and defecate, a drop in taste, tactile sensitivity, smell, increased sweating. The thyroid gland increases significantly in size, heart rhythm disturbances and a decrease in blood pressure are observed.

Micromercurialism is a chronic poisoning with all of the above symptoms that occurs with constant exposure to small amounts of mercury over many years.

Consequences of mercury poisoning

In the absence of timely assistance with acute mercury poisoning, death can occur.

People with chronic intoxication are not able to lead their usual way of life and become psychologically disabled.

Mercury is especially dangerous for pregnant women, since there is a high risk of developing intrauterine pathologies.

Is it possible to detect an excess concentration of mercury vapor in a room?

Of course, with the development of any situation that carries the risk of exceeding the permissible concentration of mercury in the air, it is necessary to invite a special accredited laboratory and take measurements (the standard is not more than 0.0003 mg/m3).

There are also household tests that will help you navigate the mercury concentration in the indoor air (paper that is impregnated with copper iodide or selenium sulfide), which allow you to determine if there is an increase in the maximum allowable concentration during 8-10 hours of observation.

Treatment

Acute poisoning is treated only in a hospital, in a complex or differentiated way, taking into account the lesion. Chronic mercury poisoning is treated both in a hospital and in sanatoriums. Also, one of the methods of treatment of chronic mercury poisoning is a transfer to another job. For treatment, special preparations are used: Dimercaptosuccinic acid, Taurine, Methionine, Unithiol.

Prevention

In case of accidental damage to a household thermometer or an energy-saving lamp, it is necessary to perform the entire set of measures to eliminate the incident.

People who work in industries associated with constant contact with mercury recommend rinsing the mouth with potassium chlorate or potassium permanganate during and after work.

In case of poisoning with mercury salts, raw egg white is a good adsorbent - it is enough to take a few proteins inside.