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Radioactive Cesium and Thallium: Prussian Blue
Ferric hexacyanoferrate, also known as Prussian blue, is a prescription medication
approved by the FDA for the treatment of internal contamination with cesium or thallium.
Prussian blue is taken orally, is not absorbed by the gastrointestinal tract, and serves as an
ion exchanger during the enterohepatic cycling of these isotopes. During the Goiania
incident, 249 individuals were exposed to cesium-137 from an abandoned medical
radiotherapy device. Forty-six of these individuals were treated with Prussian blue,
including 13 children who received daily doses up to 3 g/day in 3 divided doses. Prussian
blue treatment reduced the whole-body effective half-life of Cs-137 by 46% in
adolescents and by 43% in children 4–12 years of age.
Dosage and administration of Prussian blue:
• Adults and adolescents: 3 g, PO, tid.
• Children (2–12 yr): 1 g, PO, tid.
• Dosing in infants and neonates has not been established.
Treatment should start as soon as possible after contamination is suspected and continue
for a minimum of 30 days.
Prussian blue is manufactured as a 500-mg gelatin capsule and is available directly from
the manufacturer, Heyl, in Germany. Supplies are also maintained by the U.S. Strategic
National Stockpile and are available from the Radiation Emergency Action
Center/Training Site (REAC/TS), Oak Ridge, TN. Significant side effects are rare and
consist mainly of mild to moderate constipation.
Radioactive Plutonium, Americium, and Curium: DTPA
Uranium: Bicarbonate
Diethylenetriaminepentaacetate (DTPA) is a powerful chelating agent effective in
removing some heavy metal isotopes. In 2004, the FDA approved calcium-DTPA and
zinc-DTPA for treatment of individuals with known or suspected internal contamination
with plutonium, americium, or curium to increase the rates of elimination. These
chelators, however, should not be used to decorporate for uranium because of potential
renal toxicity. Instead, for uranium, urine alkalinization with bicarbonate should be done
in an effort to promote excretion (Table 6.10).
Dosage and administration of DTPA. There are two salts of DTPA, Ca-DTPA and Zn-
DTPA. In general, treatment should be started with Ca-DTPA on the first day and then
changed to Zn-DTPA on the second day. This is because Ca-DTPA is more effective than
Zn-DTPA on the first day, while being no more effective than Zn-DTPA later on. It does,
however, have increased risks of causing metabolic abnormalities. It is supplied as 1 g in
5 mL of diluent, and is currently available from the U.S. Strategic National Stockpile and
from the Radiation Emergency Action Center/Training Site (REAC/TS), Oak Ridge, TN,
and directly from the manufacturer in Germany.
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