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

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, Order on line at for $ CFR Part 20 REAC/TS website for information on Prussian blue, Ca/Zn-DTPA: Medical Management of Radiological Casualties, 2 nd ed., Apr., 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 2H FAX