Medical cadmium removal actions triggered by initial medical surveillance*

Biological measurement	Normal levels	Elevated levels, non-mandatory removal	Highly elevated levels, non-mandatory removal	Highly elevated levels, mandatory removal
Cadmium in urine (CdU)^¶	≤3	>3 and ≤7	>7	>7
Cadmium in blood (CdB)^Δ	≤5	>5 and ≤10	>10	>10
Beta-2 (beta2MU)^◊	≤300	>300 and ≤750	>750	>750
Trigger level	All three measurements at normal levels.	Any one measurement at an elevated level.	Any one measurement at a highly elevated level.	After confirmed follow-up testing within 90 days, either CdU or CdB remains at a highly elevated level, or beta2MU remains at a highly elevated level and either CdU or CdB is at an elevated level.
Risk at this level	Negligible or relatively low risk of renal tubular proteinuria (ie, consistent with the background rate among the general population).	Elevated risk of renal tubular proteinuria (ie, above the background level experienced by the general population).	Elevated, and perhaps highly elevated, risk of renal tubular proteinuria (ie, above the background level experienced by the general population). Risk may not be abnormal if beta2MU is highly elevated and CdU and CdB are at normal levels.^§	Highly elevated risk of renal tubular proteinuria.
Actions	Provide annual biological monitoring and biennial medical examinations.	Provide semiannual biological monitoring and annual medical examinations until all measurements return to normal levels.	If medically removed from job: Provide quarterly biological monitoring and semiannual medical examinations until clinician decides to return employee to job or permanently remove the employee from job. If not medically removed from job: Provide quarterly biological monitoring and semiannual medical examinations until all measurements return to normal levels.	Mandatory medical removal required. Provide quarterly biological monitoring and semiannual medical examinations until clinician decides to return employee to job or permanently remove the employee from job.

CdU: cadmium in urine; CdB: cadmium in blood; beta2MU: beta-2 microglobulin in urine.
* This table only addresses those actions designed to decrease cadmium; other requirements may apply based on the results of the other medical examinations.
¶ CdU = CdU mcg per gram of creatinine in urine.
Δ beta2MU = beta2MU mcg per gram of creatinine in urine
◊ CdB = CdB mcg per liter of whole blood.
§ In cases in which the beta2MU is highly elevated and CdU and CdB are at normal levels, the clinician should check to determine that the beta2MU levels accurately reflect the true beta2MU levels. If they do, then the clinician must determine the cause of the highly elevated levels of proteins in urine (eg, presence of end-stage renal disease or immune-deficiency diseases).

Reproduced from: OSHA Brief. Medical evaluation of renal effects of cadmium exposure. Available at: https://www.osha.gov/Publications/OSHA_3675.pdf (Accessed on April 13, 2016).

Graphic 107690 Version 1.0

خرید پکیج

Medical cadmium removal actions triggered by initial medical surveillance*