Isotope |
Ionizing radiation decay mode |
Radioactive half-life |
Biological half-life |
Major exposure pathways |
Focal accumulation |
Treatment: References for use |
Fact sheets
(CDC,
ATSDR,
EPA,
Argonne Natl. Lab) |
Americium (Am-241) |
α |
458 years |
73,000 days |
Inhalation Skin |
Lungs Liver Bone Bone marrow |
DTPA† * |
CDC
ATSDR
EPA
Argonne (PDF - 39 KB)
|
Californium (Cf-252) |
α, γ |
2.6 years |
N/A |
Inhalation Ingestion |
Bone Liver |
DTPA* |
Argonne (PDF - 39 KB) |
Cesium (Cs-137) |
β, γ |
30 years |
70 days |
Inhalation Ingestion |
Follows potassium; renal excretion |
Prussian blue, insoluble† * |
CDC
ATSDR
EPA
Argonne (PDF - 39 KB)
|
Cobalt (Co-60) |
β, γ |
5.26 years |
9.5 days |
Inhalation |
Liver |
Succimer (DMSA)§ (DailyMed) DTPA* EDTA§ N-Acetyl-L-cysteine§ |
CDC
ATSDR
EPA
Argonne (PDF - 38 KB)
|
Curium (Cm-244) |
α, γ, neutron |
18 years |
Liver: 7,300 days Bone: 18,250 days |
Inhalation Ingestion |
Liver Bone |
DTPA† * |
Argonne (PDF - 42 KB) |
Iodine (I-131) |
β, γ |
8.1 days |
138 days |
Inhalation Ingestion Skin |
Thyroid |
Potassium iodide† *
Saturated solution of potassium iodide§
Propylthiouracil§
Methimazole§
Potassium iodate§ |
CDC
ATSDR
EPA
Argonne (PDF - 38 KB)
|
Iridium (Ir-192) |
β, γ |
74 days |
50 days |
N/A |
Spleen |
Consider DTPA*
Consider EDTA§ |
CDC
Argonne (PDF - 95 KB)
|
Isotope |
Ionizing radiation decay mode |
Radioactive half-life |
Biological half-life |
Major exposure pathways |
Focal accumulation |
Treatment: References for use |
Fact sheets
(CDC,
ATSDR,
EPA,
Argonne Natl. Lab) |
Phosphorus (P-32) |
β |
14.3 days |
1,155 days |
Inhalation Ingestion Skin |
Bone Bone marrow Rapidly replicating cells |
Hydration + Phosphate drugs
|
|
Plutonium (Pu-239) |
α |
2.2 x 104 years |
73,000 days |
Inhalation (limited absorption) |
Lung Bone Bone marrow Liver Gonads |
DTPA§
DFOA§
EDTA§
DTPA + DFOA§
|
CDC
ATSDR
EPA
Argonne (PDF - 58 KB)
|
Polonium (Po-210) |
α |
138.4 days |
60 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 - 41 KB)
HPS (PDF - 492 KB)
NRC
More references
|
Radium (Ra-226) |
α, β, γ |
1,602 years |
16,400 days |
Ingestion |
Bone |
Aluminum hydroxide*
Barium sulfate*
Sodium alginate§
Calcium phosphate§
|
ATSDR
EPA
Argonne (PDF - 52 KB)
|
Strontium (Sr-90) |
β |
28 years |
18,000 days |
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 - 39 KB)
|
Isotope |
Ionizing radiation decay mode |
Radioactive half-life |
Biological half-life |
Major exposure pathways |
Focal accumulation |
Treatment: References for use |
Fact sheets
(CDC,
ATSDR,
EPA,
Argonne Natl. Lab) |
Thorium (Th-232) |
α |
1.41 x 1010 years |
Bone: 8,030 days Liver/total body: 700 days |
Inhalation Ingestion |
Bone |
Consider DTPA* |
ATSDR
EPA
Argonne (PDF - 49 KB)
|
Tritium (H-3) |
β |
12.5 years |
12 days |
Inhalation Ingestion Skin |
Whole body |
Water diuresis* |
EPA
Health Protection Agency (UK)
|
Uranium (U-235) |
α |
7.1 x 108 years |
15 days |
Ingestion |
Kidneys Bone |
Sodium bicarbonate*
For high level intake consider off-label diuretics and/or dialysis§ |
CDC
ATSDR
EPA
Argonne (PDF - 46 KB)
|
Yttrium (Y-90)¶ |
β |
64 hours |
N/A |
Inhalation Ingestion |
Bone |
DTPA*
EDTA§ |
Argonne ¶ (PDF - 39 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
|
|
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
|
|
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
|