From Big Medical Encyclopedia

TRINITROTOLUENE, professional harm. Trinitrotoluene (synonym: tolite, tro

tit) — the explosive substance relating to the most toxic derivatives of toluene. It is used for equipment of ammunition. Let's badly dissolve in water, it is better in toluene, alcohol; let's well dissolve in lipids that promotes its bystry absorption through skin. Gets into an organism through respiratory organs, skin, partially through went. - kish. path; it is absorbed preferential by a liver; it is removed with urine in the form of pair connections of products of his metabolism with glucuronic to - that.

On the mechanism of action it is similar to toluene (see), but existence in a molecule T. nitrogroups (N02) promotes a metgemoglobinoobrazova-niya (see the Methemoglobinemia), to development of an anoxemia (see the Hypoxia), quite often to a hypocapny (see) also causes more expressed changes in a liver.

Frequency and expressiveness of intoxication depend on the operating concentration of T. and degrees of impurity of a technical product other its toxic isomers. Maximum allowable concentration in air of a working zone of 1 mg! m3.

At acute intoxications patients show complaints to a headache, dizziness, the general weakness, nausea, vomiting. At action on an organism of high concentration of T. (in emergencies) the expressed changes of c develop. N of page, the all-brain phenomena up to potern consciousnesses. Blue-gray coloring of skin and mucous membranes is characteristic. Blood dense, viscous, chocolate-brown color. The methemoglobinemia belongs to specific changes of blood, edges are defined by degree of an anoxemia. Detection in blood of erythrocytes with Heinz's little bodies — Ehrlich (the denatured hemoglobin), and also decrease in keeping of free sulphhydryl groups is characteristic.

In hard cases on 3 — the 4th day after intoxication the phenomena of hemolitic anemia are frequent (see). T. treats the hepatotropic substances capable to cause the damage of a liver which is followed by pains in the field of the right hypochondrium, increase in the sizes of a liver, the accruing jaundice, increase in level of activity of enzymes (transaminase, zymohexase), a hyperbilirubinemia with dominance bilirubin-glyukuranida. Development of acute or subacute dystrophy of a liver is in some cases possible (see. Toxic dystrophy of a liver), deep disturbance of exchange processes, the coagulative necrosis of hepatocytes which is coming to the end with a liver failure (see), development of a hepatic coma (see).

In sovr. industrial conditions easy forms of intoxication still meet the low-expressed functional disturbances of a liver. In mild cases of acute poisonings dizziness, nausea, sometimes vomiting, increase of pulse, cyanosis of lips are noted.

Hron. intoxications of T. are shown by symptoms of toxic hepatitis (see) and are followed by increase in a liver, development of dispepsichesky and painful syndromes, and also dyskinesia of bilious ways. Decrease in excretory function of a liver belongs to early disturbances. In the expressed cases there occurs change of pigmental function with increase in level of bilirubin in blood serum. Morphologically dystrophic changes in hepatocytes with dominance of fatty dystrophy come to light (see). In blood — a reticulocytosis, Heinz's little bodies — Ehrlich in erythrocytes, decrease in keeping of free sulphhydryl groups. In the expressed cases of intoxication — moderate anemia of hemolitic character. At hron. intoxications development of a professional cataract, the first signs a cut is possible can be observed after two-three years of contact with T.

First aid and l e h e-N and e. At acute intoxications of the victim

TRIPANOVY SINIYA should immediately 269

bring out of the gas-polluted room, to remove the contaminated T. clothes. At hit of a product on skin plentifully wash out the contaminated places water and weak-pink solution of potassium permanganate. The thermal procedures strengthening formation of a methemoglobin, in particular a hot bathtub or a shower are contraindicated. At the expressed methemoglobinemia for the purpose of strengthening of process of a demetgemoglobinization introduction of 1% of solution methylene blue in 40% solution of glucose is shown. At an anoxemia for the purpose of increase in amount of the oxygen dissolved in plasma — an oxygenotherapy, at a hypocapny — Carbogenum. At severe damages of a liver — in the first days an artificial diuresis, Trasylolum, Contrykal, lipotropic means — sincaline chloride, methionine, lipamidum. At high activity of process — steroid hormones. According to indications appoint cardiovascular means.

At hron. intoxications which are followed by preferential damage of a liver vitamins of group B, drugs of lipotropic action are shown (sincaline chloride, lipoic, folic to - you). In the subsequent are shown a dignity. - hens. treatment (Yessentuki, Zheleznovodsk), drugs of an aminoquinolinic row. At dyskinesia of bilious ways apply cholagogue and antispasmodics.

Examination of working capacity. At initial easily reversible manifestations of influence of T. the patient is temporarily transferred to other work, at the expressed resistant phenomena — directed to VTEK.

Prevention of poisonings includes mechanization of productions, sealing of the equipment, improvement of ventilation. Frequent change of overalls, a daily warm shower after work, a periodic dignity are of great importance. instructing of working. Carrying out preliminary and periodic medical surveys is obligatory (see. Medical examination).

Bibliography: Artamonova V. G. and

Shatalov H. H. Occupational diseases, page 293, M., 1982; Harmful substances in the industry, under the editorship of N. V. Lazarev and E. N. Levina, t. 2, page 259, L., 1976;

Skaya N. M., Popov T. B. Konchalov and B I am l to about N. K. Current state of a problem of toxic hepatitis, Gigabyte. work and the prof. having got sick., No. 12, page 10, 1974; Occupational diseases, under the editorship of E. M. Tareeva and A. A. Bezrodnykh, page 209, M., 1976; To Russia a century and I am A. M., etc. Occupational diseases, page 283, M.,

1973; The Guide to occupational diseases, under the editorship of N. F. Izmerov, t. 1, page 125, M., 1983. A. M. Rashevskaya.