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	Managing Internal Contamination Isotopes of Interest: Properties, Treatment, and Fact Sheets Radiation Countermeasures for Treatment of Internal Contamination Isotopes of Interest: Properties, Treatment, and Fact Sheets Information in this table adapted from: Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I), National Council on Radiation Protection and Measurements, Bethesda, MD, 2008. Tochner ZA, Glatstein E, Internal Contaminant Radionuclides: Properties and Treatment (Table 216-1) in "Chapter 216: Radiation Bioterrorism," in Harrison's Principles of Internal Medicine, 17th Edition, Fauci AS, Longo DL, Kasper DL, Braunwald E, Jameson JL, Loscalzo J, Hauser SL, eds., pp. 1358-1364, McGraw Hill, 2008. View/Print as PDF (PDF - 74 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) 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 Sodium glycerophosphate§ Sodium phosphate§ Potassium phosphate§ Calcium carbonate§ Aluminum hydroxide§ Aluminum carbonate§ Sevelamer§ (DailyMed)   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) References for use † FDA approved: Countermeasures so marked have been approved as treatment for internal contamination with the listed radioisotope by the US Food and Drug Administration (FDA). * NCRP preferred: Countermeasures so marked have been listed as preferred treatments for internal contamination with the listed radioisotope by the National Council on Radiation Protection and Measurements [Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I)]. Except where noted, use of these countermeasures has not been approved by the US Food and Drug Administration (FDA). § NCRP suggested: Countermeasures so marked have been listed as suggested treatments for internal contamination with the listed radioisotope by the National Council on Radiation Protection and Measurements [Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I)]. Use of these countermeasures has not been approved by the US Food and Drug Administration (FDA). 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) More Polonium-210 references Understanding Radiation - Topics: Polonium 210 (Health Protection Agency) Individual Monitoring Conducted by the Health Protection Agency in the London Polonium-210 Incident (Health Protection Agency) Jefferson RD, Goans RE, Blain PG, Thomas SH. Diagnosis and treatment of polonium poisoning. Clin Toxicol (Phila.) 2009 May; 47(5):379-92. [PubMed Citation] Harrison J, Leggett R, Lloyd D, Phipps A, Scott B. Polonium-210 as a Poison. J Radiol Prot. 2007 Mar;27(1):17-40. [PubMed Citation] Scott BR. Health risk evaluations for ingestion exposure of humans to polonium-210. Dose Response. 2007;5:94-122. (PDF - 175 KB) ¶ For Yttrium-90 radioactive properties and health concerns, see Strontium-90 Human Health Fact Sheet top of page Radiation Countermeasures for Treatment of Internal Contamination Medical countermeasure information in this table adapted from: Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I), National Council on Radiation Protection and Measurements, Bethesda, MD, 2008. Population Monitoring and Radionuclide Decorporation Following a Radiological or Nuclear Incident (NCRP Report No. 166), National Council on Radiation Protection and Measurements, Bethesda, MD, 2011. FDA drug information related to radiation emergencies Caveats about Radiation Countermeasures for Treatment of Internal Contamination View/Print as PDF (PDF - 66 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 2-4 tablets (400 mg - 800 mg/tab) TID Not to exceed 1600 mg TID 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 100 mg capsules Administer 10 mg/kg or 350 mg/m2 every 8 hr for 5 days, then reduce; safety and efficacy in children <12 years has not been established 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 References for use FDA approved: Countermeasures so marked have been approved as treatment for internal contamination with the listed radioisotope by the US Food and Drug Administration (FDA). NCRP preferred: Countermeasures so marked have been listed as preferred treatments for internal contamination with the listed radioisotope by the National Council on Radiation Protection and Measurements [Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I)]. Except where noted, use of these countermeasures has not been approved by the US Food and Drug Administration (FDA). NCRP suggested: Countermeasures so marked have been listed as suggested treatments for internal contamination with the listed radioisotope by the National Council on Radiation Protection and Measurements [Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I)]. Use of these countermeasures has not been approved by the US Food and Drug Administration (FDA). top of page

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