Managing Internal Contamination
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Isotopes of Interest: Properties, Treatment, and Fact Sheets
* Adapted from "Radiation Bioterrorism", Tochner ZA, Lehavi O, Glatstein E, Chapter 207 in Harrison's Principles of Internal Medicine. Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, eds. 16th Edition, pp 1294-1300, McGraw-Hill, 2005
See also:
Summary of Radioactive Properties for Selected Radionuclides (PDF - 145 KB) (Human Health Fact Sheet, Argonne National Laboratories, 2005)
Radiological and Chemical Fact Sheets to Support Health Risk Analyses for Contaminated Areas (PDF - 2.34 MB) (Argonne National Laboratories, 2007)
Isotope Name & Symbol |
Ionizing Radiation Type |
Radiological Half-life |
Biologic Half-life (days) |
Exposure Type |
Mode of Contamination |
Focal Accumulation in Body |
Treatment |
Related Isotopes:
Fact Sheets
(CDC,
ATSDR,
EPA,
Argonne Natl. Lab) |
Americium
(Am-241) |
α |
458 years |
73,000 |
Internal |
Inhalation,
skin wounds |
Lungs, liver,
bones, bone marrow
|
Chelation with DTPA‡ |
CDC (PDF - 73 KB);
ATSDR (PDF - 24 KB);
EPA;
Argonne (PDF - 39 KB)
|
Californium
(Cf-252) |
α, γ |
2.6 years |
N/A |
Internal |
Lungs,
GI tract |
Bones, liver |
Chelation with DTPA† |
Argonne (PDF - 39 KB) |
Cesium
(Cs-137) |
β, γ |
30 years |
70 |
External,
Internal |
Lungs,
GI tract,
wounds, follows potassium |
Renal excretion |
Ion exchange with
Prussian blue‡ |
CDC (PDF - 74 KB);
ATSDR (PDF - 25 KB);
EPA;
Argonne (PDF - 39 KB)
|
| Cobalt
(Co-60) |
β, γ |
5.26 years |
9.5 |
External,
Internal |
Lungs |
Liver |
Gastric lavage;
Limited animal data suggest that DTPA, EDTA, L-cysteine, NAC (N-Acetyl-Cysteine), and glutathione may be effective in increasing urinary excretion. § |
CDC (PDF - 74 KB);
ATSDR (PDF - 25 KB);
EPA;
Argonne (PDF - 38 KB)
|
Curium
(Cm-244) |
α, γ, neutron |
18 years |
7,300 (liver)
18,250 (bones) |
Internal |
Inhalation,
GI tract |
Liver, bones (soluble Cm compounds) |
Chelation with DTPA‡ |
Argonne (PDF - 42 KB) |
| Iodine
(I-131) |
β, γ |
8.1 days |
138 |
Internal |
Inhalation,
GI tract,
wounds |
Thyroid |
Potassium iodide‡, propylthiouracil†, methimazole†, sodium iodide† |
CDC (PDF - 75 KB);
ATSDR (PDF - 702 KB);
EPA;
Argonne (PDF - 38 KB)
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Iridium
(Ir-192) |
β, γ |
74 days |
50 |
External,
Internal |
Not available |
Spleen |
Not available |
CDC;
Argonne (PDF - 95 KB)
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Isotope Name & Symbol |
Ionizing Radiation Type |
Radiological Half-life |
Biologic Half-life (days) |
Exposure Type |
Mode of Contamination |
Focal Accumulation in Body |
Treatment |
Related Isotopes:
Fact Sheets
(CDC,
ATSDR,
EPA,
Argonne Natl. Lab) |
Phosphorus
(P-32) |
β |
14.3 days |
1,155 |
Internal |
Inhalation,
GI tract,
wounds |
Bones, bone marrow, rapidly replicating cells |
Lavage,
Aluminum hydroxide†,
Dibasic phosphates† |
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| Plutonium
(Pu-239) |
α |
2.2 x 104 years |
73,000 |
Internal |
Limited lung absorption, high retention |
Lung, bones,
bone marrow,
liver, gonads |
Chelation with DTPA‡ |
CDC (PDF - 80 KB);
ATSDR (PDF - 109 KB);
EPA;
Argonne (PDF - 58 KB)
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Polonium
(Po-210) |
α |
138.4 days |
60 |
Internal |
Inhalation,
GI tract,
wounds |
Spleen, kidneys, lymph nodes, bone marrow, liver, mucus lining cells of the lung |
Lavage,
Dimercaprol† |
CDC;
Review article 1;
Review article 2 (PDF - 174 KB);
Argonne (PDF - 41 KB);
HPS (PDF - 79 KB);
NRC;
HPA
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| Radium
(Ra-226) |
α, β, γ |
1,602 years |
16,400 |
External,
Internal |
GI tract |
Bones |
MgSO4 lavage†,
Ammonium chloride†,
Calcium†,
Alginates†,
Calcium gluconate† |
ATSDR (PDF - 112 KB);
EPA;
Argonne (PDF - 52 KB)
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| Strontium
(Sr-90) |
β |
28 years |
18,000 |
Internal |
Moderate GI tract |
Bones - similar to calcium |
Stable strontium†,
Calcium†,
Ammonium chloride†,
Calcium gluconate†,
Sodium alginate†,
Aluminum-containing antacids† |
CDC (PDF - 73 KB);
ATSDR (PDF - 25 KB);
EPA;
Argonne (PDF - 39 KB)
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Isotope Name & Symbol |
Ionizing Radiation Type |
Radiological Half-life |
Biologic Half-life (days) |
Exposure Type |
Mode of Contamination |
Focal Accumulation in Body |
Treatment |
Related Isotopes:
Fact Sheets
(CDC,
ATSDR,
EPA,
Argonne Natl. Lab) |
Thorium
(Th-232) |
α |
1.41 x 1010 years |
8,030
(bones)
700
(liver, total body) |
Internal |
Inhalation,
GI tract |
Bones |
Chelation with DTPA† |
ATSDR;
EPA;
Argonne (PDF - 49 KB)
|
| Tritium
(H-3) |
β |
12.5 years |
12 |
Internal |
Inhalation,
GI tract,
wounds |
Total body |
Dilution with controlled water intake, Diuretics |
EPA;
HPA
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| Uranium
(U-235) |
α |
7.1 x 108 years |
15 |
Internal |
GI tract |
Kidneys, bones |
Sodium bicarbonate† |
CDC (PDF - 69 KB);
ATSDR (PDF - 91 KB);
EPA;
Argonne (PDF - 46 KB)
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| Yttrium
(Y-90) |
β |
64 hours |
N/A |
Internal |
Inhalation,
GI tract |
Bones |
Chelation with DTPA† |
Argonne¶ (PDF - 39 KB)
|
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† Not FDA approved for this indication / Off-label use
‡ FDA approved for this indication
§ References:
- Llobet JM, Domingo JL, Corbella J. Comparison of antidotal efficacy of chelating agents upon acute toxicity of Co(II) in mice. Res Commun Chem Pathol Pharmacol. 1985 Nov;50(2):305-8. [PubMed Citation]
- Llobet JM, Domingo JL, Corbella J. Comparison of the effectiveness of several chelators after single administration on the toxicity, excretion and distribution of cobalt. Arch Toxicol. 1986 Apr;58(4):278-81. [PubMed Citation]
- Generic procedures for medical response during a nuclear or radiological emergency (PDF - 2225 KB) (IAEA April 2005)
¶ For Yttrium-90 radioactive properties and health concerns information, see Strontium-90 Human Health Fact Sheet
* Adapted from "Radiation Bioterrorism", Tochner ZA, Lehavi O, Glatstein E, Chapter 207 in Harrison's Principles of Internal Medicine. Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, eds. 16th Edition, pp 1294-1300, McGraw-Hill, 2005
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Countermeasures for Treatment
See also: Hematopoietic Countermeasures for Acute Radiation Syndrome — Growth factors/cytokines, doses and indications
 Caution and Comments about Radiation Countermeasures for Treatment
Medication | Administered
for Isotopes | Route of Administration & Dosage | Duration | Mechanism of Action |
|---|
Aluminum hydroxide† |
Strontium-90 |
PO:
60-100 mL |
Once |
Decreased gut absorption |
Aluminum phosphate gel† |
Strontium-90 |
PO:
100 mL immediately after exposure |
Once |
Decreased gut absorption |
Ammonium chloride† |
Strontium-90,
Radium-226 |
PO:
1-2 g q.i.d |
6 days |
Increased excretion |
Calcium† |
Strontium-90,
Radium-226 |
PO:
Generous doses |
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Increased excretion |
Ca-DTPA‡,
Zn-DTPA‡ |
Plutonium-239,
Americium-241,
Curium-244,
Californium-252§,
Thorium-232§,
Yttrium-90§ |
IV:
1 g in 250 mL NS or 5% glucose, given in 1-2 h, or bolus over 3-4 min; given once daily as a single infusion
Nebulized Inhalation:
1 g in 1:1 dilution with water or NS over 15-20 min
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Up to 5 days |
Chelating agent |
Calcium gluconate† |
Strontium-90,
Radium-226 |
IV:
5 ampules (500 mg calcium each) in 500 mL D5W over 4 h |
6 days |
Increased excretion |
Dimercaprol† |
Mercury, Lead, Arsenic, Gold, Polonium-210 |
IM:
300 mg/vial for deep IM use,
2.5 mg/kg (or less) q4h x 2 days,
then bid for 1 day,
then qd for days 5-10
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10 days |
Chelating agent |
Medication | Administered for Isotopes | Route of Administration & Dosage | Duration | Mechanism of Action |
|---|
Potassium iodide‡ |
Iodine-131 |
PO:
Adults >40 years of age
with thyroid exposure ≥ 500 cGy:
130 mg/d (See details)
Adults 18-40 years of age
with thyroid exposure ≥ 10 cGy:
130 mg/d (See details)
Pregnant or lactating women
with thyroid exposure ≥ 5 cGy:
130 mg/d (See details)
Adolescents approaching adult size (≥70 kg)
with thyroid exposure ≥ 5 cGy:
130 mg/d (See details)
Children and adolescents 3-18
with thyroid exposure ≥ 5 cGy:
65 mg/d (See details)
Infants 1 month to 3 years
with thyroid exposure ≥ 5 cGy:
32.5 mg/d (See details)
Neonates from birth to 1 month
with thyroid exposure ≥ 5 cGy:
16 mg/d (See details)
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- In some incidents only a single dose of KI is required.
- Incident Managers may recommend additional daily doses if radioactive iodine ingestion (or inhalation) is a continuing threat.
- In some incidents, a course of 7-14 days may be recommended.
- See details
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Blocking agent |
Potassium phosphate, dibasic† |
Phosphorus-32 |
PO:
250 mg phosphorus per tablet.
Adults: 1-2 tabs p.o. qid, with full glass of water each time, with meals and at bedtime.
Children over 4y: 1 tab qid. |
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Blocking agent |
Medication | Administered for Isotopes | Route of Administration & Dosage | Duration | Mechanism of Action |
|---|
Propylthiouracil† |
Iodine-131 |
PO:
50 mg tabs, 2 tabs tid x 8 days |
8 days |
Blocking agent |
Prussian blue‡ |
Cesium-137,
Thallium-201 |
PO (Adults):
- 1 - 3 g tid with 100-200 mL water, up to 10 g/d
Children:
- Not FDA approved for children under 2 years old (IND or EUA may be required)
- Pediatric details in package insert
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≥3 weeks, titrated by urine and fecal bioassay and whole-body counting |
Ion exchanger |
Sodium alginate† |
Strontium-90,
Radium-226 |
PO:
10 g powder in a 30 cc vial, add water and drink |
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Decreased gut absorption |
Sodium bicarbonate† |
Uranium-235 |
IV:
- 2 ampules sodium bicarbonate (44.3 meq each) in 1000 mL D5W, 125 mL/h, or
- 1 ampule of sodium bicarbonate (44.3 meq) in 500 mL D5W, 500 mL/h
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- Usually IV for the first 24 h, maybe continued as necessary;
- Continuation of treatment for >3 days is rare and can be done according to titration of uranium amounts in the body
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Increased excretion via the kidneys |
Sodium phosphate† |
Phosphorus-32 |
See Potassium phosphate |
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Water† |
Tritium (H-3) |
PO:
>3-4 L per day |
3 weeks |
Excretion of water |
† Not FDA approved for this indication / Off-label use
‡ FDA approved for this indication
§ Ca-DTPA/Zn-DTPA has not been approved by FDA for treating contamination with californium, thorium, and yttrium
Adapted from:
1. "Radiation Bioterrorism", Tochner ZA, Lehavi O, Glatstein E, Chapter 207 in Harrison's Principles of Internal Medicine, Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, eds. 16th Edition, pp 1294-1300, McGraw-Hill, 2005
2. Marcus, CS. Administration of decorporation drugs to treat internal radionuclide contamination: medical emergency response to radiologic incidents. RSO Magazine, 2004;9(5):9-15. (PDF - 34 KB)
See also: Hematopoietic Countermeasures for Acute Radiation Syndrome — Growth factors/cytokines, doses and indications
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Treatment of Internal Contamination - General Information
- Type of decontamination treatment is determined by the type(s) of radionuclide(s) involved in the exposure.
- Objective of therapy is to decrease the absorbed radiation dose and thereby reduce the risk of future biological effects.
- Methods of treatment include:
- Diluting agents: e.g. controlled water diuresis for tritium
- Blocking agents: e.g. Potassium Iodide (KI) for Iodine-131
- Chelating agents: e.g. Zn-DTPA and Ca-DTPA for plutonium and transuranics
- Gastric lavage: e.g. for cobalt contamnation in special situation
- Pulmonary lavage: e.g. for plutonium in lungs in special situations
- Emetics: e.g. for cobalt
- Purgative/laxative/enemas: e.g. for cobalt
- Table above provides a summary of treatment options for internal contamination by several radionucldes.
These agents should be used by the medical staff in consultation with a professional who is knowledgeable about treating radiological injuries.
- Questions regarding indications for therapy, onset and type of treatment, and immediate and long-term follow-up should be directed to a specialist, such as a hospital Radiation Safety Officer, nuclear medicine physician, radiation oncologist, or toxicologist.
- Additional advice may be obtained by contacting:
Caution and Comments about Radiation Countermeasures for Treatment
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