INTERNAL CONTAMINATION

Internal contamination is the result of ingestion, inhalation, or contamination of open wounds with radioactive material. Treat these patients like an occult toxic exposure with a full toxicology work up. Isotope identification, as ascertained by exposure history or use of detection equipment, is crucial in the determination of medical management. Some general principles apply to the care of these patients based on reducing ongoing exposure and incorporation. Available methods of reducing internal contamination include blocking, dilution, chelation, and altering the chemistry to enhance elimination of the isotope from the body. Lavage or cathartics can reduce absorption in the GI tract; pulmonary load can be reduced by bronchoalveolar lavage; and contamination in wounds can be excised or washed. Direct further treatment at decorporation of the isotope.

There are a limited number of countermeasures which are approved for use in cases involving radioactive cesium, strontium, iodine, and plutonium. Medical intelligence, modeling, and use of radionuclide detectors will help create a comprehensive picture for diagnosis and treatment of internal contamination. Management of internal contamination should occur as described in Table 10 within 24 hours post-event and if outside the initial 24-hour window pursue treatment based upon expert guidance and recommendation. Potassium iodide is of limited utility outside of nuclear power accidents and in pregnant/breastfeeding women and children. Treatment for some of the more common isotopes is listed in Table 11.

RADIOIODINE PROTECTION

- Use of KI for protection of the thyroid
- Administer early
- Ideally before exposure within 24 hours
- Preferably within 4 hours post exposure
- Protection lasts 24 hours
- Dose daily as long as there is a risk
- Prioritize sheltering in place for those intolerant of KI, pregnant and lactating females (FDA.gov)

Table 11. Treatment options for selected radionuclides.
Figure 7. Current USFDA Radiation Countermeasures and Under Development