DECORPORATION DRUGS TO TREAT INTERNAL RADIONUCLIDE CONTAMINATION*

*ADAPTED from Carol S. Marcus, Ph.D., MD PowerPoint Presentation

RADIOLOGIC INCIDENTS

• Accidents in the USA and Canada are unusual– Generally contained; involve few individuals

• Terrorist incidents would not be contained– Could involve tens of thousands of people

• Physician involvement– Few have significant experience– Generally limited to KI to decrease thyroid uptake

of I-131 from various radiopharmaceuticals

DISPERSION DEVICES

• RADIOLOGICAL DISPERSION DEVICE (RDD) EVENTS– Explosive (“dirty bomb”)– Surreptitious (unnoticed spread)– Destruction of site containing radioactive material,

sealed and/or unsealed (e.g. nuclear power plant, hospital)

– Detonation of nuclear weapon

MEDICAL PERSONNEL

• MAY BE FACED WITH:– External contamination– Inhaled contamination– Ingested contamination– Wound contamination (e.g. radioactive shrapnel)

THERAPY REQUIREMENTS

• INSTITUTION OF DECORPORATION THERAPY REQUIRES:– Identification of radionuclide(s)– Screening of victims– Quantitation of internal contamination– Therapy thresholds– Stockpiled pharmaceuticals

PRINCIPAL CONCERNS

• MAIN RADIONUCLIDES FROM RDD’S– Strontium (Sr)-90– Yttrium (Y)-90– Cesium (Cs)-137– Iridium (Ir)-192– Cobalt (Co)-60– Americium (Am)-241– Iodine (I)-125 and 131

RDD’S CONT’D

• RADIONUCLIDES FROM RDD’S– Uranium (U)-234, 235, 238– Plutonium (Pu)-239– Radium (Ra)-226– Tritium (H)-3– Phosphorus (P)-32– Palladium (Pd)-103– Mixtures

IDENTIFICATION

• METHODS TO IDENTIFY – Gamma ray spectra– Beta emitters– Alpha emitters– Clues from site explosion– Role of radiation regulators, DOE, and nuclear

professionals

THRESHOLDS

• THERAPY THRESHOLDS– May use “allowable levels of intake” for workers

(ALI’s)– May use higher contamination thresholds based on

deterministic effects– Political pressure for very low thresholds

ACCESS

• DECORPORATION DRUG ACCESS– FDA-approved drugs, approved indications– FDA-approved drugs, unapproved indications– FDA-unapproved drugs, available from a

compounding pharmacy– OTC drugs

STOCKPILE EXAMPLE

• LOS ANGELES COUNTY DEPT. OF HEALTH SERVICES-EMERGENCY MEDICAL SERVICES AGENCY STOCKPILE– Prussian blue– Ca/Zn-DTPA– Ca gluconate– Na alginate– D-penicillamine– Ammonium chloride– Na bicarbonate– Dimercaprol (BAL)

TREATMENT OVERVIEW

• RADIOELEMENT AND DECORPORATION TREATMENT OVERVIEW– Americium: parenteral Ca/Zn-DTPA– Cesium: oral Prussian blue– Cobalt: nothing too good, but oral penicillamine

worth trying– Iodine: KI within about first 4 hours; consider

PTU– Iridium: unknown; try penicillamine

TREATMENT OVERVIEW

• TREATMENT OVERVIEW – Palladium: unknown; try oral penicillamine– Phosphorus: oral Na or K phosphate– Plutonium: parenteral Ca/Zn-DTPA– Radium: oral Ca, alginates

TREATMENT OVERVIEW

• TREATMENT OVERVIEW– Strontium: i.v. Ca gluconate, oral ammonium

chloride, alginates– Tritium: force water to promote diuresis– Uranium: Ca/Zn-DTPA within 4 hrs only; Na

bicarbonate– Yttrium: parenteral Ca/Zn-DTPA

ALI’S

• THE ALLOWABLE LEVELS OF INTAKE (ALI’S) FOR RADIATION WORKERS:– Found in 10 CFR Part 20– By ingestion and inhalation– By halflife of chemical compound (days, weeks, or

years)

REFERENCES

• NCRP Report No. 65, Management of Persons Accidentally Contaminated with Radionuclides, April 15, 1980. Order on line at www.ncrp.com for $50.00.

• 10 CFR Part 20

• REAC/TS website for information on Prussian blue, Ca/Zn-DTPA: www.orau.gov/reacts/

• Medical Management of Radiological Casualties, 2nd ed., Apr., 2003. AFRRI, Bethesda, MD.

KI CANADA LTD

• For more information, please contact:

• Tom Gottlieb• Senior VP Research• KI Canada ltd,• 707 Alness Street • Toronto Ontario M3J 2H8• 416 661 1818 FAX 416 661 1816