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No significant side effects from its usage have been reported, although cases of nausea,
vomiting, diarrhea, chills, fever, pruritus, and muscle cramps have been noted in the first
24 hours after administration when given repeatedly and with short intervals allowed for
recovery.
Adults and adolescents. The initial dose of Ca-DTPA is 1 g IV. On day 2, start Zn-
DTPA at 1 g as daily maintenance dose. Pregnant women should begin and continue with
Zn-DTPA. Nursing mothers should not breastfeed if they are suspected of having internal
radionuclide contamination.
Children younger than 12 years of age. The initial dose of Ca-DTPA is 14 mg/kg IV.
On day 2, start Zn-DTPA at 14 mg/kg as daily maintenance dose.
Other Radioactive Isotopes
Because every element has one or more radioactive isotopes, there are hundreds of
different radioactive isotopes. Each radioactive isotope behaves chemically the same as
the non-radioactive isotope of the same element. Treatment of internal radioisotope
contamination depends on the specific chemical properties of each isotope. The main
radioactive isotopes that have caused internal contamination in people are described
above. Detailed information about the diagnosis and treatment of these and other
radioactive isotopes is available in the National Council on Radiation Protection Report
No.65 and also by calling REAC/TS or the Armed Forces Radiobiology Research
Institute (AFRRI).
Surgical Issues
Local Radiation Injury: Cutaneous Radiation Syndrome (CRS)
A complication of external contamination or of close contact with a radioactive source is
the effect of local radiation on tissues and organ systems (see Figure 6.10). This scenario
along with partial body exposure has occurred more often than incidents involving whole
body irradiation in past radiation mishaps. Local radiation injury will also alter the
clinical course of patients suffering from acute radiation syndrome (ARS). In fact,
significant morbidity and mortality in these cases may result from local injury rather than
from ARS itself. The damage to tissues results in the release of endogenous toxins into
the circulatory system, resulting in high body temperatures, metabolic disorders and
neurological complications.
The basic pathophysiology involves the response of the various cell types of the skin and
organs that are exposed to radiation. That response is a function of the relative
radioresponsiveness of the tissues involved. Individual cell types respond differently
based on the amount of radiation delivered. The individual cellular response to radiation
is also a function of its lineage, its level of development or maturity, and the stage during
cell division when it is irradiated. Cell lineage is important because some cells are more
radiosensitive (e.g., erythroblasts) than others (e.g., muscle cells). The developmental
stage during which a cell is irradiated also is an important determinant of cellular
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