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Re: AW: Emergency Preparedness
At 08:09 PM 1/6/03 +0100, Franz Schoenhofer wrote:
- -----Ursprüngliche Nachricht-----
- Von: owner-radsafe@list.vanderbilt.edu
[mailto:owner-radsafe@list.vanderbilt.edu]Im
Auftrag von Engelbretson, David A.
- Gesendet: Montag, 06. Jänner 2003 20:44
- An: radsafe@list.vanderbilt.edu
- Betreff: Emergency Preparedness
- Dear Colleagues,
-
- In regard to chemical agents used for treating certain types of RAM
exposures, are there any substitutes available for the following two
chemicals ?
-
- Ferric ferrocyanide (Prussian Blue), a blocking agent for Cs-137,
is not recognized by the U.S. Pharmacopeia and is not approved by the
FDA.
-
- DTPA, a chelating agent, is not commercially available either. I
believe it is only available under Investigational New Drug (IND) permits
for treatment of persons contaminated internally with plutonium. However,
calcium EDTA is available and has effectiveness for the transuranium
metals, but DTPA is generally more
effective
.
-
- -----------------------------------------------------
-
- Dave,
-
- I cannot recommend you any substitutes, but I offer you the
possibility to think a little about the use of such chemicals.
-
- Regarding Prussian Blue: It is not really a "blocking
agent", but complexes caesium (also Cs-137 and Cs-134) strongly -
this is known since decades and has been used to remove Cs-137 from
drinking water and milk and has actually been used to enrich Cs-137 from
drinking water in order to measure its concentration. It has been used
after the Chernobyl accident to reduce Cs-137 levels in meat (for
instance in Norway, where sheep were treated with ferrocyanides) and the
levels in milk. For the latter purpose, which actually did use a slightly
different ferrocyanide ("Gieses salt") I recently found a paper
which I had not had track of for years, so if somebody is interested I
could forward the site, where it can be retrieved.
- However, the efficiency of reducing Cs-137 levels in meat and milk is
rather limited. A reduction by a factor of two or at most three in meat
and milk is something, which is in my opinion not worth the effort. In
case of a very severy case of internal contamination by Cs-137, which
might result in extremely high doses I personally would not hesitate to
swallow ferrocyanides, whether they are approved or not.
-
- Regarding DTPA: It is of course commercially available as well as all
kind of ferrocyanides. Contamination with plutonium or americium should
not occurr frequently unless in places with a potential for it and there
health physicists should be prepared to it, so I personally would swallow
that stuff, if such internal contamination - in a range of causing very
high doses - occurred to me.
-
- I would be very surprised, if it would not be possible to use in a
real emergency situation - not ingestion of femto-Becquerels - such
agents. I remember an Austrian Standard for Internal Decontamination I
have worked with many years ago. I would have to look it up, but as far
as I remember we recommended the use of complexing agents and we did not
bother about their official approval. Moreover I think to remember that
Health Physics has published during the last 20 years several papers on
the decorporation of radionuclides.
-
- Best regards,
-
- Franz
-
-
Dear Radsafers:
It is not necessary to wait (forever?) for the USFDA to approve Prussian
blue, Ca-DTPA, or Zn-DTPA. It is available from compounding
pharmacists in the US. As long as a physician prescribes it for
either a particular patient or as stock for an emergency response team or
hospital, these drugs may be used as any other drug in the practice of
medicine. It only has to be treated as an "experimental"
drug if you get it from Oak Ridge, and you need to be on their IND for
that, and they will not let emergency response teams be on their IND.
Thank goodness for pharmacists! You can order it, for example, from
Custom Care Pharmacy in Florida. Their prices are very
reasonable.
1-800-995-4363
Ciao, Carol
Carol S. Marcus, Ph.D., M.D.
<csmarcus@ucla.edu>