Hostname: page-component-848d4c4894-nr4z6 Total loading time: 0 Render date: 2024-06-01T14:18:51.540Z Has data issue: false hasContentIssue false
  • English
  • Français

Americium Inhalational Exposure with Successful Chelation Therapy

Published online by Cambridge University Press:  17 August 2021

Michael Keenan ,
Torsten Behrens ,
Stan Bravenec ,
Jason Davis ,
Angie Bowen ,
Ronald Goans  and
Carol Iddins
Michael Keenan*
Affiliation:
Department of Emergency Medicine, University at Buffalo, Buffalo, NY, USA
Torsten Behrens
Affiliation:
Department of Emergency Medicine, University at Buffalo, Buffalo, NY, USA
Stan Bravenec
Affiliation:
VHA Medical Emergency Radiological Response Team, Washington, DC, USA
Jason Davis
Affiliation:
Radiation Emergency Assistance/Training Site (REAC/TS), Oak Ridge, TN, USA
Angie Bowen
Affiliation:
Radiation Emergency Assistance/Training Site (REAC/TS), Oak Ridge, TN, USA
Ronald Goans
Affiliation:
Radiation Emergency Assistance/Training Site (REAC/TS), Oak Ridge, TN, USA MJW Corporation, Buffalo, NY, USA
Carol Iddins
Affiliation:
Radiation Emergency Assistance/Training Site (REAC/TS), Oak Ridge, TN, USA
*
Corresponding Author: Michael Keenan, Email: keenanm2017@gmail.com.
Get access Rights & Permissions [Opens in a new window]

Abstract

Americium is a man-made metal produced in very small quantities in nuclear reactors. Americium-241 is one of the radioactive isotopes of americium and has commercial applications, including use in smoke detectors. This is a case report of an occupational inhalation of americium-241, treated with both effective external decontamination and the use of diethylenetriamine pentaacetate to promote decorporation. This experience is significant because of the potential for americium or similar radionuclides to be used in “dirty” bombs or other radiological dispersion devices to cause large-scale radioactive contamination.

Keywords

AmericiumRadiation InjuriesChelationToxicologyDTPA
Type
Report from the Field
Information
Disaster Medicine and Public Health Preparedness , Volume 16 , Issue 5 , October 2022 , pp. 2185 - 2189
Copyright
© Society for Disaster Medicine and Public Health, Inc. 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Rella, JG. Radiation. In: Nelson, LS, Howland, M, Lewin, NA, et al., eds. Goldfrank’s Toxicologic Emergencies, 11th ed. New York, NY: McGraw-Hill; 2010:1762-1775. http://accessemergencymedicine.mhmedical.com/content.aspx?bookid=2569&sectionid=210265086. Accessed June 7, 2019.Google Scholar
Centers for Disease Control and Prevention. Public health statement: americium. CAS#: 7440-35-9. Agency for Toxic Substances and Disease Registry; 2004.Google Scholar
Walter, FG. Radiation Emergencies. In: Walter, FG, Klein, R, Thomas, RG, eds. Advanced Hazmat Life Support Provider Manual, 5th ed. Phoenix, AZ: Arizona Board of Regents; 2017.Google Scholar
Rella, JG. Pentetic acid or pentetate (zinc or calcium) trisodium (DTPA). In: Nelson, LS, Howland, M, Lewin, NA, et al., eds. Goldfrank’s Toxicologic Emergencies, 11th ed. New York, NY: McGraw-Hill; 2010:1779-1782. http://accessemergencymedicine.mhmedical.com/content.aspx?bookid=2569&sectionid=210264230. Accessed June 9, 2019.Google Scholar
Oak Ridge Institute for Science and Education. Hameln pharmaceutical information. October 2016. https://orise.orau.gov/reacts/documents/calcium-dtpa-package-insert.pdf. Accessed January 2, 2020.Google Scholar
Akorn Pharmaceuticals. Pentetate calcium trisodium injection [package insert]. March 2013. https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/021749s008lbl.pdf. Accessed January 2, 2020.Google Scholar
Akorn Pharmaceuticals. Pentetate zinc trisodium injection [package insert]. March 2013. https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/021751s008lbl.pdf. Accessed January 2, 2020.Google Scholar
Kazzi, ZN, Heyl, A, Ruprecht, J. Calcium and zinc DTPA administration for internal contamination with plutonium-238 and americium-241. Curr Pharm Biotechnol. 2012;13:1957-1963.CrossRefGoogle ScholarPubMed
Carbaugh, EH, Lynch, TP, Cannon, CN, Lewis, LL. Case study: three acute 241Am inhalation exposures with DTPA therapy. Health Phys. 2010;99(4):539-546.Google ScholarPubMed
Ménétrier, F, Grappin, L, Raynaud, P, et al. Treatment of accidental intakes of plutonium and americium: guidance notes. Appl Radiat Isot. 2005;62(6):829-846. doi: 10.1016/j.apradiso.2005.01.005.Google ScholarPubMed
National Council on Radiation Protection and Measurements. Management of persons contaminated with radionuclides: scientific and technical bases. NCRP Report No. 161 II. Bethesda, MD: NCRP; 2009.Google Scholar
Miccoli, L, Ménétrier, F, Laroche, P, Grémy, O. Chelation treatment by early inhalation of liquid aerosol DTPA for removing plutonium after rat lung contamination. Radiat Res. 2019;192(6):630-639. doi: 10.1667/RR15451.Google ScholarPubMed
Grémy, O, Tsapis, N, Bruel, S, et al. Decorporation approach following rat lung contamination with a moderately soluble compound of plutonium using local and systemic Ca-DTPA combined chelation. Radiat Res. 2012;178(3):217-223. doi: 10.1667/rr2866.1.Google ScholarPubMed
Stather, JW, Stradling, GN, Smith, H, et al. Decorporation of 238PuO2 from the hamster by inhalation of chelating agents. Health Phys. 1982;42(4):520-525.Google ScholarPubMed
Stradling, GN, Stather, JW, Sumner, SA, et al. Decorporation of inhaled americium-241 dioxide and nitrate from hamsters using ZnDTPA and Puchel. Health Phys. 1984;46(6):1296-1300.Google ScholarPubMed
Stradling, GN, Stather, JW, Sumner, SA, et al. Decorporation of inhaled plutonium nitrate from hamsters using Zn-DTPA. Health Phys. 1984;46(4):919-924.Google ScholarPubMed
Stradling, GN, Henge-Napoli, MH, Paquet, F, et al. Optimum treatment regimens with animals. Radiat Prot Dosimetry. 2000;87(1):29-40. https://doi.org/10.1093/oxfordjournals.rpd.a032977.Google Scholar
Stradling, GN, Taylor, DM, Henge-Napoli, MH, et al. Treatment for actinide-bearing industrial dusts and aerosols. Radiat Prot Dosimetry. 2000;87(1):41-50. https://doi.org/10.1093/oxfordjournals.rpd.a032978.CrossRefGoogle Scholar
Bondesson, E, Bengtsson, T, Nilsson, LE, Wollmer, P. Site of deposition and absorption of an inhaled hydrophilic solute. Br J Clin Pharmacol. 2007;63(6):722-731. doi: 10.1111/j.1365-2125.2006.02835.x.Google ScholarPubMed
Guilmette, RA, Muggenburg, BA. Reducing the radiation dose from inhaled americium-241 using continuously administered DTPA therapy. Int J Radiat Biol Relat Stud Phys Chem Med. 1988;53(2):261-271. doi: 10.1080/09553008814550611.CrossRefGoogle ScholarPubMed
Mays, CW, Taylor, GN, Fisher, DR. Estimated toxicity of Ca-DTPA to the human fetus. Health Phys. 1976;30(2):247-249.Google Scholar
Fairbanks, VF, Warsom, MD, Beutler, E. Drugs for iron overload. Br J Med. 1963;1(5342):14-15.CrossRefGoogle Scholar
Kemble, JV. The new chelating agent Ca-DTPA in the treatment of primary haemochromatosis. Guys Hosp Rep. 1964;113:68-73.Google ScholarPubMed
Fahey, JL, Rath, CE, Princiotto, JV, et al. Evaluation of trisodium calcium diethylenetriaminepentacetate in iron storage disease. J Lab Clin Med. 1961;57:436-439.Google ScholarPubMed
Toohey, RE, Kathren, RL. Overview and dosimetry of the Hanford americium accident case. Health Phys. 1995;69(3):310-317.Google ScholarPubMed
Breitenstein, BD. 1976 Hanford americium exposure incident: medical management and chelation therapy. Health Phys. 1983;45(4):855-866.Google ScholarPubMed
United Nations Scientific Committee on the Effects of Atomic Radiation. UNSCEAR 2017 Report to the General Assembly, with Scientific Annexes. Sources, effects, and risks of ionizing radiation. United Nations. New York; 2018.Google Scholar
International Commission on Radiation Protection. ICRP Publication 118. ICRP statement on tissue reactions and early and late effects of radiation in normal tissues and organs – threshold doses for tissue reactions in a radiation protection context. Ann ICRP. 2012;41(1–2):1-322.Google Scholar
Klumpp, J, Bertelli, L, Waters, T. Interpretation of nasal swab measurements following suspected releases of actinide aerosols. Health Phys. 2017;112(5):465-469.Google ScholarPubMed
VHA Directive 0320.05 Medical Emergency Radiological Response Team Program. Department of Veterans Affairs. Veterans Health Administration. August 12, 2019. https://www.va.gov/vhapublications/publications.cfm?pub=1&order=asc&orderby=pub_Number. Accessed January 7, 2020.Google Scholar
Bolch, WE, Hurtado, JL, Lee, C, et al. Guidance on the use of hand-held survey meters for radiological triage: time-dependent detector count rates corresponding to 50, 250, and 500 mSv effective dose for adult males and adult females. Health Phys. 2012;102(3):305-325.CrossRefGoogle Scholar
Adams, TG, Casagrande, R. Screening internal contamination of inhaled and ingested radionuclides with hand-held survey meters. Health Phys. 2018;114(3):299-306.CrossRefGoogle ScholarPubMed
Bertelli, L, Melo, DR, Lipsztein, JL, Cruz-Suarez, R. AIDE: internal dosimetry software. Radiat Prot Dosimetry. 2008;130:358-367.Google ScholarPubMed
International Commission on Radiation Protection. ICRP Publication 66. Human respiratory tract model for radiological protection. Oxford (UK) Pergamon: ICRP; 1994.Google Scholar
International Commission on Radiological Protection. ICRP Publication 67. Age dependent doses to members of the public from intake of radionuclides: Part 2. Ingestion dose coefficients. Appendix B: age-specific biokinetic models for plutonium, americium, and neptunium. New York, Elsevier, Annals of ICRP 23:3/4; 1993.Google Scholar
Oak Ridge Institute for Science and Education. Information for treating patients with illnesses or injuries caused by ionizing radiation. Radiation Emergency Assistance Center/Training Site (REAC/TS) website. n.d. https://orise.orau.gov/resources/reacts/guide/index.html. Accessed October 28, 2020.Google Scholar
Oak Ridge Institute for Science and Education. Emergency preparedness and subject matter expertise on the medical management of radiation incidents. Radiation Emergency Assistance Center/Training Site (REAC/TS) website. n.d. https://orise.orau.gov/reacts/. Accessed October 28, 2020.Google Scholar
Gillette, NA, Hahn, FF, Mewhinney, JA, Muggenberg, BA. Osteosarcoma development following single inhalation exposure to americium-241 in beagle dogs. Radiat Res. 1985;104(1):83-93.Google Scholar