Diseases Caused by Nitroglycerine

1. Introduction and Definitions

Nitroglycerine, also known as glyceryl trinitrate, is a heavy, colorless, oily, explosive liquid primarily used in the manufacture of explosives and as a medication for heart conditions. While its medical use is beneficial, occupational exposure to nitroglycerine can lead to serious health issues. This article provides comprehensive information on diseases caused by nitroglycerine, targeting occupational health nurses and doctors.

2. Agent Causes the Disease

Nitroglycerine exposure occurs mainly through inhalation of vapors or dermal absorption. In industrial settings, workers can be exposed during the production, handling, and disposal of nitroglycerine and nitroglycerine-based products. Prolonged or high-level exposure can lead to both acute and chronic health effects, primarily affecting the cardiovascular system.

3. Workers at Risk of This Disease

Several occupations and tasks put workers at higher risk of nitroglycerine exposure, including:

  • Explosives Manufacturing Workers: Involved in the production and handling of explosives containing nitroglycerine.
  • Munitions Workers: Handling and assembling munitions with nitroglycerine components.
  • Pharmaceutical Industry Workers: Involved in the production of nitroglycerine-based medications.
  • Chemical Plant Workers: Handling raw materials and byproducts containing nitroglycerine.
  • Demolition Workers: Exposed to nitroglycerine residues during demolition activities involving explosives.

4. Symptoms

Symptoms of diseases caused by nitroglycerine exposure can vary depending on the level and duration of exposure:

  • Acute Exposure: Symptoms include headache (often referred to as "Monday disease" due to its recurrence after weekends off), dizziness, nausea, vomiting, palpitations, and hypotension. Severe exposure can lead to methemoglobinemia, characterized by cyanosis and respiratory distress.
  • Chronic Exposure: Long-term exposure can result in tolerance to the vasodilatory effects of nitroglycerine, leading to withdrawal symptoms such as chest pain and hypertension when exposure ceases. Chronic effects also include persistent headaches, dizziness, and fatigue.

5. Diagnosis

Diagnosing diseases caused by nitroglycerine involves a combination of clinical evaluation, occupational exposure assessment, and specific tests:

  • Medical History and Physical Examination: Detailed assessment of the patient's work history and symptoms.
  • Blood Tests: Including methemoglobin levels to assess methemoglobinemia.
  • Cardiovascular Assessment: Monitoring blood pressure, heart rate, and conducting ECGs to detect cardiovascular abnormalities.
  • Neurological Evaluation: For workers presenting with chronic headaches and dizziness.
  • Occupational Exposure Monitoring: Measuring nitroglycerine levels in the workplace to assess exposure risk.

6. Treatment

Treatment for diseases caused by nitroglycerine focuses on managing symptoms and preventing further exposure:

  • Remove from Exposure: Immediate removal from the source of nitroglycerine exposure is crucial.
  • Symptomatic Treatment: Providing medications to manage cardiovascular symptoms, including vasodilators for hypertension and antianginal medications for chest pain. Methane blue may be administered for methemoglobinemia.
  • Supportive Care: Including oxygen therapy for respiratory distress and hydration for hypotension.
  • Gradual Withdrawal: To mitigate withdrawal symptoms, gradually reducing exposure rather than abrupt cessation.
  • Long-term Monitoring: Regular follow-up to monitor cardiovascular and neurological health.

7. Prevention

Preventing diseases caused by nitroglycerine involves implementing strict control measures in the workplace:

  • Engineering Controls: Using local exhaust ventilation, enclosed processes, and proper maintenance of equipment to reduce airborne exposure.
  • Work Practices: Implementing safe work practices such as proper handling and disposal of nitroglycerine-containing materials, and avoiding eating, drinking, or smoking in areas where nitroglycerine is used.
  • Personal Protective Equipment (PPE): Providing and ensuring the use of appropriate respirators, protective clothing, and gloves.
  • Health Surveillance: Regular health screenings, including cardiovascular assessments and monitoring of methemoglobin levels for workers exposed to nitroglycerine.
  • Education and Training: Informing workers about the hazards of nitroglycerine and safe work practices to minimize exposure.

By recognizing the hazards of nitroglycerine exposure and applying effective preventive strategies, occupational health professionals can substantially lower the occurrence of related illnesses and improve the overall health and safety of workers.

Workplace Exposure Limits:

  • OSHA PEL (Permissible Exposure Limit):

    • Time-Weighted Average (TWA): 0.2 ppm (2 mg/m³) [skin exposure].
    • Short-Term Exposure Limit (STEL): Not specified.
  • NIOSH REL (Recommended Exposure Limit):

    • TWA: Not specified.
    • STEL: 0.1 mg/m³ (not to be exceeded during any 15-minute work period).