Use of a chelating agent should be considered immediately following an accidental
intake of plutonium that exceeds the facility action levels (as suggested in Section
5.9). For maximum effectiveness, the chelating agent should be administered as soon
as possible following the accidental intake of plutonium. Both the zinc or calcium
salts of DTPA are approved for human use and are available under Investigational
New Drug (IND) Permits for treating internal plutonium contamination. The worker
to be treated must first be informed of the proposed use of an experimental drug,
instructed on the purpose of administering the chelating agent, and warned about the
possible side-effects of the drug. The worker must then give signed consent before
DTPA chelation therapy may be initiated. Even though DTPA therapy is the only
method available for reducing the quantity of plutonium or americium retained in the
body, the affected worker has the right to refuse its use.
The recommended therapy for decorporation is 1-g CA-DTPA or ZN-DTPA by
intravenous injection or infused in 250-mL normal saline or 5% glucose in water,
infused intravenously over 1 hour (Gerber and Thomas, 1992; NCRP, 1980).
Treatment may be continued if bioassay indicates that decorporation therapy
continues to enhance the urinary excretion of plutonium. Extended therapy has
shown no ill effects (Carbaugh et al., 1989).
CA-DTPA should not be administered to potentially fertile female workers. Instead,
ZN-DTPA should be used for internal decorporation of plutonium and other
5.10.5 Contaminated Wounds
Medical treatment for contaminated wounds may include flushing with saline and
decorporating solutions, debridement, and surgical excision of the wound. These
measures are all the responsibility of trained medical staff operating under the
direction of a physician. Health physics personnel can provide valuable assistance by
prompt assessment of materials removed from the wound and identification of
magnitude of residual activity as decontamination proceeds. Decontamination should
continue until all radioactivity has been removed or until risk of permanent physical
impairment is reached.