Mixture of fission products EMERGENCY TREATMENT First administer potassium iodide (or Lugol's solution if Potassium iodide is not available), then Ca-DTPA, and finally Prussian Blue. 1 Potassium iodide If not available, Lugol's solution can be used as an alternative. SEE SHEET 39 PRESENTATION Potassium iodide, 65 mg tablets (PCA – Central Pharmacy of the Armed Forces). DOSAGE Adults (including pregnant women): 2 tablets. Children (3 to 12 years): 1 tablet. Children (1 month to 3 years): ½ tablet (may be dissolved in water, milk or fruit juice). Newborns (< 1 month): 16 mg, i.e. ¼ tablet. To be effective, the iodine tablet must be taken ideally a few hours before exposure to the radioactive particles and gases and within 8 hours afterwards at the most. In the event of a nuclear or radiological accident, the tablets pre-distributed to the public must only be taken when formally instructed to do so by the competent authorities (Prefect or high command in a military environments). The treatment must not be renewed unless instructed to do so by the competent authorities. 2 Pentetate calcium trisodium No demonstrated clinical effectiveness, but usable due to its good tolerance profile. PRESENTATION Ca-DTPA 250 mg/ml, injectable solution. 4 ml vial (PCA – Central Pharmacy of the Armed Forces). DOSAGE Persons > 12 years: slow IV injection or infusion in 15 min of a half-vial of Ca-DTPA (i.e. 0.5 g), diluted in 100 to 200 ml of isotonic saline solution or 5% glucose solution, without exceeding 1 g/d. Children (< 12 years): slow IV injection or infusion 14 mg/kg, without exceeding 0.5 g/d. TREATMENTS COMPLEMENTARY TO INTRAVENOUS ADMINISTRATION ▪ Pulmonary contamination Adults – Children (to be used with caution): 1 g in a single administration by inhalation – nebulisation only (spray mist, 50/50 dilution of a 4 ml vial in sterile or saline water). ▪ Contaminated wounds Pour one or more vials over the wound. 3 Prussian Blue (Iron ferrocyanide) PRESENTATION RADIOGARDASE® 500 mg capsules (SERB). DOSAGE Persons > 12 years: 1 g, 3 times a day, i.e. 3 g/d. Children (2 to 12 years): 0.5 g, 3 times a day, i.e. 1.5 g/d. Children (< 2 years): no data being available, the administration of Prussian Blue must be evaluated with respect to the risks involved. The capsules must be swallowed with a drink or with foodstuffs; food intake speeds up biliary secretion and the enterohepatic cycle. With patients who have difficulty swallowing, the capsules can be opened and their content mixed with the food or a liquid (e.g. a mannitol solution). RADIONUCLIDE HANDBOOK • Emergency treatment of internal contamination RH 31
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