Guidance for Radiation Accident Management

Introduction

Basics of Radiation

Detection

Measurement

Safety Around Radiation Sources

Types of Radiation Exposure

Managing Radiation Emergencies

Manage radiation emergencies

Guidance for Hospital Medical Management

Managing Emergency Care || Radiation Injury ||  Acute Radiation Syndrome || Internal Contamination


Treatment of Internal Contamination

Once radioactive materials cross cell membranes, they are said to be incorporated. Incorporation is a time-dependent, physiological phenomenon related to both the physical and chemical natures of the contaminant.  Incorporation can be quite rapid, occurring in minutes, or it can take days to months. Thus, time can be critical and prevention of uptake is urgent. Several methods of preventing uptake (e.g., catharsis, gastric lavage) might be applicable and can be prescribed by a physician. Some of the medications or preparations used in decorporation might not be available locally and should be stocked when a decontamination station is being planned and equipped. Examples of specific agents used for selected radionuclides can be seen in the table below. Expert guidance is available from NCRP 65, poison control centers, or call REAC/TS (865-576-3131) or the 24-hour emergency number (865-576-1005).

If internal contamination is suspected or has occurred, the physician or radiation safety officer should request samples of urine, feces, vomitus, wound secretion, etc. Whole-body counting and radioassay can help evaluate the magnitude of the problem and the effect of any treatment. The contaminated patient admitted with an airway or endotracheal tube must be considered to be internally contaminated.

Treatment for Selected Internal Contaminants

Radionuclide Medication For Ingestion/Inhalation Principle of Action
Iodine KI (potassium iodide) 130 mg (tabl) stat, followed by 130 mg q.d. x 7 if indicated Blocks  thyroid deposition
Rare earths
Plutonium
Transplutonics
Yttrium
Zn-DTPA
Ca-DTPA
1 gm Ca-DTPA (Zn-DTPA) in 150-250 ml 5 percent D/W IV over 60 minutes Chelation
Uranium Bicarbonate 2 ampules sodium bicarbonate (44.3 mEq each; 7.5%) in 1000 cc normal saline @ 125 cc/hr; alternately, oral administration of two bicarbonate tablets every 4 hours until the urine reaches a pH of 8-9 Alkalinization of urine; reduces chance of acute tubular necrosis
Cesium
Rubidium
Thallium
Prussian Blue
[Ferrihexacyano- Ferrate (II)]
1 gm with 100-200 ml water
p.o. t.i.d. for several days
Blocks absorption from GI tract and prevents recycling.
Tritium Water Force fluids Isotopic dilution
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