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Managing Internal Contamination



Isotopes of Interest: Properties, Treatment, and Fact Sheets

Information in this table adapted from:

Print as PDF View/Print as PDF (PDF - 74 KB)

Isotope

Ionizing radiation
decay mode

Radioactive half-life

Major exposure pathways

Focal accumulation

Treatment:
References for use

Fact sheets
(CDC, ATSDR, EPA,
Argonne Natl. Lab, Wikipedia)

Americium
(Am-241)

α

458 years

Inhalation
Skin

Lungs
Liver
Bone
Bone marrow

DTPA *

CDC
ATSDR
EPA
Argonne (PDF - 2.34 MB)
Wikipedia

Californium
(Cf-252)

α, γ

2.6 years

Inhalation
Ingestion

Bone
Liver

DTPA*

Argonne (PDF - 2.34 MB)
Wikipedia

Cesium
(Cs-137)

β, γ

30 years

Inhalation
Ingestion

Follows potassium; renal excretion

Prussian blue, insoluble *

CDC
ATSDR
EPA
Argonne (PDF - 2.34 MB)
Wikipedia

Cobalt
(Co-60)

β, γ

5.26 years

Inhalation

Liver

Succimer (DMSA)§ (DailyMed)
DTPA*
EDTA§
N-Acetyl-L-cysteine§

CDC
ATSDR
EPA
Argonne (PDF - 2.34 MB)
Wikipedia

Curium
(Cm-244)

α, γ, neutron

18 years

Inhalation
Ingestion

Liver
Bone

DTPA *

Argonne (PDF - 2.34 MB)
Wikipedia

Iodine
(I-131)

β, γ

8.1 days

Inhalation
Ingestion
Skin

Thyroid

Potassium iodide *
Saturated solution of potassium iodide§
Propylthiouracil§
Methimazole§
Potassium iodate§

CDC
ATSDR
EPA
Argonne (PDF - 2.34 MB)
Wikipedia

Iridium
(Ir-192)

β, γ

74 days

N/A

Spleen

Consider DTPA*
Consider EDTA§

CDC
Argonne (PDF - 2.34 MB)
Wikipedia

Isotope

Ionizing radiation
decay mode

Radioactive half-life

Major exposure pathways

Focal accumulation

Treatment:
References for use

Fact sheets
(CDC, ATSDR, EPA,
Argonne Natl. Lab, Wikipedia)

Phosphorus
(P-32)

β

14.3 days

Inhalation
Ingestion
Skin

Bone
Bone marrow
Rapidly replicating cells

Hydration + Phosphate drugs

Wikipedia

Plutonium
(Pu-239)

α

24,100 years

Inhalation (limited absorption)

Lung
Bone
Bone marrow
Liver
Gonads

DTPA§
DFOA§
EDTA§
DTPA + DFOA§

CDC
ATSDR
EPA
Argonne (PDF - 2.34 MB)
Wikipedia
IEER

Polonium
(Po-210)

α

138.4 days

Inhalation
Ingestion
Skin

Spleen
Kidneys
Lymph nodes
Bone marrow
Liver
Lung mucosa

Gastric Lavage
Dimercaprol (BAL)*
Succimer (DMSA)§ (DailyMed)
D-Penicillamine§ (DailyMed)

CDC
Argonne (PDF - 2.34 MB)
HPS (PDF - 492 KB)
NRC
Wikipedia
More references

Radium
(Ra-226)

α, β, γ

1,602 years

Ingestion

Bone

Aluminum hydroxide*
Barium sulfate*
Sodium alginate§
Calcium phosphate§

ATSDR
EPA
Argonne (PDF - 2.43 MB)
Wikipedia

Strontium
(Sr-90)

β

28 years

Inhalation
Ingestion

Bone

Inhalation:
Calcium gluconate§
Barium sulfate§

Ingestion:
Rx is the same as for radium (see above). Additional Rx may include stable strontium compounds:
Strontium lactate§
Strontium gluconate§

CDC
ATSDR
EPA
Argonne (PDF - 2.34 MB)
Wikipedia

Isotope

Ionizing radiation
decay mode

Radioactive half-life

Major exposure pathways

Focal accumulation

Treatment:
References for use

Fact sheets
(CDC, ATSDR, EPA,
Argonne Natl. Lab, Wikipedia)

Thorium
(Th-232)

α

1.41 x 1010 years

Inhalation
Ingestion

Bone

Consider DTPA*

ATSDR
EPA
Argonne (PDF - 2.34 MB)
Wikipedia

Tritium
(H-3)

β

12.5 years

Inhalation
Ingestion
Skin

Whole body

Water diuresis*

EPA
Public Health England (PHE), formerly Health Protection Agency (HPA), (UK)
Wikipedia

Uranium
(U-235)

α

7.1 x 108 years

Inhalation
Ingestion

Kidneys
Bone

Sodium bicarbonate*

For high level intake consider off-label diuretics and/or dialysis§

CDC
ATSDR
EPA
Argonne (PDF - 2.34 MB)
Wikipedia

Yttrium
(Y-90)

β

64 hours

Inhalation
Ingestion

Bone

DTPA*
EDTA§

Argonne (PDF - 2.34 MB)
Wikipedia


References for use
FDA approved: Countermeasures so marked have been approved as treatment for internal contamination with the listed radioisotope by the US Food and Drug Administration (FDA).

* NCRP preferred: Countermeasures so marked have been listed as preferred treatments for internal contamination with the listed radioisotope by the National Council on Radiation Protection and Measurements [Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I)]. Except where noted, use of these countermeasures has not been approved by the US Food and Drug Administration (FDA).

§ NCRP suggested: Countermeasures so marked have been listed as suggested treatments for internal contamination with the listed radioisotope by the National Council on Radiation Protection and Measurements [Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I)]. Use of these countermeasures has not been approved by the US Food and Drug Administration (FDA).


See also:
More Polonium-210 references ¶ For Yttrium-90 radioactive properties and health concerns, see Strontium-90 Human Health Fact Sheet

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Radiation Countermeasures for Treatment of Internal Contamination

Medical countermeasure information in this table adapted from:

Caution sign Caveats about Radiation Countermeasures for Treatment of Internal Contamination

Print as PDF View/Print as PDF (PDF - 66 KB)

Medical countermeasure

Administered for

Mechanism of action

Route of administration

Dosage

Duration of treatment

References for use

Aluminum carbonate

Phosphorus (P-32)

Phosphate binder

PO

600 mg tablet TID or 400mg/5 cc TID

 

NCRP-suggested

Aluminum hydroxide

Radium (Ra-226)

Strontium (Sr-90)

Blocks intestinal absorption

PO

Adults: 60-100 mL (1200 mg)

Children: 50 mg/kg, not to exceed the adult dose

Give one dose within 24 hr of radionuclide intake to block intestinal absorption; administer before absorption occurs

NCRP-preferred

Phosphorus (P-32)

Phosphate binder

PO

600 mg tablet TID or

320 mg/5cc TID

 

NCRP-suggested

Barium sulfate

Radium (Ra-226)

Strontium (Sr-90)

Blocks intestinal absorption

PO

100-300 g (as a single dose in 250 cc water)

Give one dose within 24 hr of radionuclide intake to block intestinal absorption; administer before absorption occurs

NCRP-suggested

Calcium carbonate

Radium (Ra-226)

Strontium (Sr-90)

Competes for bone binding sites

PO

Use as directed on label

Begin therapy within 12 hr of radionuclide intake if possible

NCRP-suggested

Calcium gluconate

Radium (Ra-226)

Strontium (Sr-90)

Competes for bone binding sites; phosphate binder

IV

5 ampoules (500 mg Ca/amp) in 500 cc 5% dextrose in water (D5W); infuse over 4-6 hours

6 days; begin therapy within 12 hr of radionuclide intake if possible

NCRP-suggested

Calcium phosphate

Radium (Ra-226)

Strontium (Sr-90)

Increases excretion

PO

1200 mg

Give one dose within 24 hr of radionuclide intake to block intestinal absorption; administer before absorption occurs

NCRP-suggested

Deferoxamine (DFOA)

Plutonium (Pu-239)

Chelating agent

IM (preferred route)

2 ampoules (500 mg DFOA/amp)

  • Give a single dose, then obtain bioassay to assess residual body burden of Pu-239

  • Repeat as indicated: 500 mg IM (preferred) or IV q4 hr x2 doses, then 500 mg IVq12 hr for 3 days

NCRP-suggested

DFOA is FDA-approved for Rx of acute and chronic iron poisoning only

IV (slow infusion)

2 ampoules (500 mg DFOA/amp) at 15 mg/kg/hr

Medical countermeasure

Administered for

Mechanism of action

Route of administration

Dosage

Duration of treatment

References for use

DTPA (calcium & zinc)

Americium (Am-241)

Californium (Cf-252)

Cobalt (Co-60)

Curium (Cm-244)

Plutonium (Pu-238 and Pu-239)

Yttrium (Y-90)

Chelating agent

IV (give once daily as a bolus or as a single infusion, i.e., do not fractionate the dose)

Adults: 1 g in 5 cc 5% dextrose in water (D5W) or 0.9% sodium chloride (normal saline, NS) slow IV push over 3-4 minutes or 1 g in 100-250 cc D5W or NS as an infusion over 30 minutes

Children < 12 years: 14 mg/kg/d slow IV push over 3-4 minutes (not to exceed 1 g/day)

  • Begin treatment with Ca-DTPA , then change to Zn-DTPA for maintenance, as indicated

  • Duration of therapy depends on total body burden and response to treatment


DTPA is FDA-approved for intravenous Rx of known or suspected internal contamination with Am, Cm, and Pu only

DTPA is FDA-approved for nebulized inhalation in adults only, and if the only route of contamination is through inhalation

DTPA is NCRP-preferred as Rx of the other isotopes listed and NCRP-suggested as a wound irrigation fluid

Nebulized inhalation (for use in adults only)

1 g in 1:1 dilution with sterile water or NS over 15-20 minutes

Wound irrigation fluid

1 g Ca- or Zn-DTPA and 10 cc 2% lidocaine in 100 cc 5% dextrose in water (D5W) or 0.9% sodium chloride (normal saline, NS)

  • Irrigation can be accompanied by IV or inhaled DTPA

  • Amount of DTPA absorbed by wound tissues cannot be measured

  • Avoid overdosing with DTPA and/or 2% lidocaine

Dimercaprol (BAL)

Polonium (Po-210)

Chelating agent

IM (300 mg/vial for deep IM injection only)

2.5 mg/kg QID x2 days (days 1 & 2), then BID x1 day (day 3), then QD (days 4-10)

10 days

NCRP-preferred

Dimercaprol (BAL) is FDA-approved for Rx of arsenic, gold and mercury poisoning and when used together with EDTA for Rx of acute lead poisoning only

Medical countermeasure

Administered for

Mechanism of action

Route of administration

Dosage

Duration of treatment

References for use

EDTA

Cobalt (Co-60)

Chelating agent

IV

1000 mg/m2/day in 500 cc 5% dextrose in water (D5W) or 0.9% sodium chloride (normal saline, NS); infuse over 8-12 hours

Given as a single dose

NCRP-suggested

EDTA is FDA-approved for Rx of lead poisoning only

IM

Divide IV dose equally into two doses and administer 8-12 hours apart

Given as a divided dose

D-Penicillamine (DailyMed)

Polonium (Po-210)

Chelating agent

PO

Adults: 0.75-1.5 g (250 mg/capsule) QD

Children: 30 mg/kg/day (250 mg/capsule) divided into 4 doses

  • Obtain bioassay to assess

  • Continue only if clinically indicated

  • D-Penicillamine has a narrow therapeutic index; use is associated with high risk of toxicity

NCRP-suggested

D-Penicillamine is FDA-approved for Rx of copper poisoning only

Potassium iodide (KI)

Iodine (I-131)

Blocking agent

PO

Adults >40 years: 130 mg/day (For projected thyroid dose ≥500 cGy)

Adults 18 - 40 years: 130 mg/day (For projected thyroid dose ≥10 cGy)

Pregnant or lactating women of any age: 130 mg/day (For projected thyroid dose ≥5 cGy)

Adolescents ≥70 kg: 130 mg/day (For projected thyroid dose ≥5 cGy)

Children & adolescents 3 - 18 years: 65 mg/day (For projected thyroid dose ≥5 cGy)

Infants & toddlers 1 month - 3 years: 32.5 mg/day (For projected thyroid dose ≥5 cGy)

Neonates from birth - 1 month: 16 mg/day (For projected thyroid dose ≥5 cGy)

  • Some incidents will require only a single dose of KI.

  • Incident managers may recommend additional daily doses if ongoing radioactive iodine ingestion or inhalation represents a continuing threat.

  • See also: Potassium Iodide (KI): Duration of Therapy.

FDA-approved

NCRP-preferred

Medical countermeasure

Administered for

Mechanism of action

Route of administration

Dosage

Duration of treatment

References for use

Potassium phosphate

Phosphorus (P-32)

Phosphate binder

PO

600-1200 mg, given in divided doses

 

NCRP-suggested

Potassium phosphate, dibasic

Phosphorus (P-32)

Phosphate binder

PO (take with full glass of water with meals and at bedtime)

Adults: 1-2 tablets (250 mg/tab) QID

Children >4 years: 1 tablet (250 mg/tab) QID

 

NCRP-suggested

Propylthiouracil

Iodine (I-131)

Blocking agent

PO

Adults: 2 tablets (50 mg/tab) TID

8 days

NCRP-suggested

Prussian blue, insoluble

Cesium (Cs-137)

Ion exchange; inhibits enterohepatic recirculation in GI tract

PO

Adults, children >12 years:

  • 1-3 g (2-6 capsules; 0.5 g insoluble Prussian blue per cap) TID; up to 10-12 g/day (based on Goiânia incident data)

  • 3 g (6 capsules; 0.5 g insoluble Prussian blue per cap) TID (see: FDA Package Insert )

Children 2 - 12 years:

  • 1 g (2 capsules; 0.5 g insoluble Prussian blue per cap) TID

  • Capsules may be opened and contents mixed with food

  • See: FDA Package Insert for pediatric prescribing information

Children <2 years: Prussian blue is not FDA-approved for use (IND or EUA may be required)

  • Minimum 30 day course per FDA

  • Obtain bioassay and whole body counting to assess treatment of efficacy

  • Duration of therapy depends on total body burden and response to treatment

Prussian blue, insoluble, is FDA-approved and NCRP-preferred for Rx of known or suspected internal contamination with radioactive Cs and/or radioactive or non-radioactive thallium; FDA-approved for ages > 2 years old only

Medical countermeasure

Administered for

Mechanism of action

Route of administration

Dosage

Duration of treatment

References for use

Sevelamer (DailyMed)

Phosphorus (P-32)

Phosphate binder

PO

  • 2-4 tablets (400 mg - 800 mg/tab) TID

  • Not to exceed 1600 mg TID

5 days if possible; first dose is the most important

NCRP-suggested

Sodium alginate

Radium (Ra-226)

Strontium (Sr-90)

Blocks intestinal absorption

PO (take with a full glass of water)

5g BID x1 day, then 1 g QID

 

NCRP-suggested

Sodium bicarbonate

Uranium (U-235)

Facilitates increased renal excretion

IV

  • 2 ampoules (44.3 mEq bicarbonate/ ampoule) in 1000 cc 5% dextrose in water (D5W) or 0.9% sodium chloride (normal saline, NS)

  • 250 cc (1-2 mEq/kg) slow infusion

Administer therapy until urine pH is 8-9 ; continue Rx for 3 days

NCRP-preferred

PO

2 tablets Q4 hr

Sodium glycerophosphate

Phosphorus (P-32)

 

PO

600-1200 mg, given in divided doses

 

NCRP-suggested

Sodium phosphate

Phosphorus (P-32)

 

PO

600-1200 mg, given in divided doses

 

NCRP-suggested

Succimer (DMSA) (DailyMed)

Polonium (Po-210)

Chelating agent

PO

  • 100 mg capsules

  • Administer 10 mg/kg or 350 mg/m2 every 8 hr for 5 days, then reduce; safety and efficacy in children <12 years has not been established

Reduce frequency of administration to 10 mg/kg or 350 mg/m2 every 12 hr for an additional 2 weeks of therapy; typical treatment course: 19 days

NCRP-suggested

DMSA is FDA-approved for the treatment of lead poisoning only

Water

Tritium (H-3)

Facilitates excretion

PO

>3-4 liters/day

3 weeks

NCRP-preferred

References for use
FDA approved: Countermeasures so marked have been approved as treatment for internal contamination with the listed radioisotope by the US Food and Drug Administration (FDA).

NCRP preferred: Countermeasures so marked have been listed as preferred treatments for internal contamination with the listed radioisotope by the National Council on Radiation Protection and Measurements [Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I)]. Except where noted, use of these countermeasures has not been approved by the US Food and Drug Administration (FDA).

NCRP suggested: Countermeasures so marked have been listed as suggested treatments for internal contamination with the listed radioisotope by the National Council on Radiation Protection and Measurements [Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I)]. Use of these countermeasures has not been approved by the US Food and Drug Administration (FDA).


















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