Table 6
Medical Guidelines
For Evaluating Employees With Exposure
| Part 1: DOSH's Requirements |
| In addition to requiring employers to train employees and
protect them from inorganic arsenic exposure, this
chapter (the Arsenic rule) requires employers to monitor
their employees' health with assistance from licensed
health care professionals (LHCPs). |
| |
For employees who will use respirators, the LHCP
will also need to provide the employer with a written
medical opinion clearing the employee for
workplace respirator use. |
| These guidelines were designed to support an informed
partnership between the LHCP and the employer when
monitoring the health of employees exposed to inorganic
arsenic. |
| The employer initiates this partnership by providing the
LHCP with a copy of the chapter and other supporting
information about the employee and job conditions. The
LHCP can then become familiar with the medical
monitoring requirements found in WAC 296-848-30030
and 296-848-30080, which address: |
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Frequency and content for routine (initial and
periodic) medical examinations and consultations; |
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Emergency and other unplanned medical follow-up; |
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Medical opinions; |
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Medical records retention and content. |
| Part 2: Inorganic Arsenic Toxicology |
| Health information about inorganic arsenic, WAC 296-848-50020 provides basic information about the
health effects and symptoms associated with inorganic
arsenic exposure. |
| In addition, consider the following information: |
| Acute Poisoning |
| Exfoliative dermatitis and peripheral neuritis may develop
in patients who survive health effects due to acute
poisoning (by ingestion). |
| Acute toxic symptoms of trivalent arsenical poisoning are
caused by severe inflammation of the mucous membranes
and greatly increased permeability of the blood
capillaries. |
| Acute and Chronic Poisoning |
| In cases of acute and chronic poisoning, toxic effects to
the myocardium (the middle layer of the heart) reported
on EKG changes are now largely discounted and are
attributed to electrolyte disturbances concomitant with
arsenicalism. |
| Arsenic has a depressant effect upon bone marrow, with
disturbances of both red blood cell production
(erythropoiesis) and myclopoiesis. |
| Chronic Poisoning |
| Cases of chronic poisoning caused by ingestion are
generally linked to patients taking prescribed
medications. However, sputum from inhaled inorganic
arsenic can be swallowed in addition to other ingested
inorganic arsenic due to hand-to-mouth transfer. |
| Skin lesions are usually melanotic and keratotic and may
occasionally take the form of an intradermal cancer of the
squamous cell type, but without infiltrative properties. |
| Chronic hepatitis and cirrhosis have been described.
Liver damage is still debated and as yet the question is
unanswered. |
| Polyneuritis may be the prominant feature, but more
frequently there are numbness and parasthenias of
"glove and stocking" distribution. Horizontal white lines
(striations) on the fingernails and toenails are commonly
seen and are considered a diagnostic accompaniment of
arsenical polyneuritis. |
| References: |
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Other sources for toxicology information include: |
|
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ToxFAQs and the Toxicological Profile for
Arsenic. Both of these free documents are
available from the Agency for Toxic Substances
and Disease Registry (ATSDR) and can be
obtained by: |
|
|
▪ |
Visiting
http://www.atsdr.cdc.gov/toxprofiles |
|
|
|
OR |
|
|
▪ |
Calling 1-888-422-8737. |
| |
|
A variety of technical resources on arsenic,
available from the National Institutes for
Occupational Safety and Health (NIOSH) by
visiting
http://www.cdc.niosh/topics/chemicals.html |
| Part 3: Clinical Evaluation of Employees Exposed to
Inorganic Arsenic |
| IMPORTANT: |
| |
When an employee will use a respirator during
work, the LHCP will need to determine whether the
employee can safely wear a respirator and what
limitations, if any, apply. |
| Guidance for Physical Examinations |
| In addition to its immediate diagnostic usefulness, a
patient's initial examination will provide a baseline for
comparing future test results. |
| This chapter establishes the minimum content for medical
examinations. Additional tests such as lateral and
oblique X rays or pulmonary function test may be useful. |
| You should also include palpation of superficial lymph
nodes and a complete blood count when employees are
exposed to any of the following compounds: |
|
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Copper aceto-arsenite; |
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Potassium arsenite; |
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Sodium arsenite; |
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Other arsenicals associated with lymphatic
cancer. |
| Arsenic trioxide and other inorganic arsenical dusts don't
give rise to radiological evidence or pneumoconiosis. |