Response to a Skin Puncture Contaminated with 238Pu at Los Alamos National Laboratory

Klumpp, John; Bertelli, Luiz; Dumit, Sara; Gadd, Milan S.; Poudel, Deepesh; Waters, Tom L.

doi:10.1097/hp.0000000000001250

Cited by 4 publications

(7 citation statements)

References 15 publications

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“…The typical minimum detectable activities (MDAs) for a 500-s wound count, assuming surface activity (<1 mm wound depth), are 10 Bq, 5 Bq, and 3 Bq for 239/240 Pu, 238 Pu, and 241 Am, respectively. For 1 to 3 mm wound depth, the corresponding MDAs are 16 Bq, 8 Bq, and 3 Bq, respectively, for 239/240 Pu, 238 Pu, and 241 Am (Klumpp et al 2020).…”

Section: Review Of Lanl Casesmentioning

confidence: 99%

Effectiveness of Surgical Excision Following Plutonium-contaminated Wounds: Inferences from Historical Cases

2023

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As with any medical treatment, the decision to excise a wound contaminated with actinides is a risk-benefit analysis. The potential benefits of surgical excision following such contaminated wounds are reduction in the probability of stochastic effects, avoidance of local effects, and psychological comfort knowing that radioactive material deposited in the wound is prevented from being systemic. These benefits should be balanced against the potential risks such as pain, numbness, infection, and loss of function due to excision. To that end, the responsibility of an internal dosimetrist is to provide advice to both the patient and the treating physician about the likely benefits of excision that include, but not limited to, averted doses. This paper provides a review of the effectiveness of surgical excisions following plutonium-contaminated wounds and finds that excisions are highly effective at removing plutonium from wounds and at averting the doses they would have caused.

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Section: Review Of Lanl Casesmentioning

confidence: 99%

Effectiveness of Surgical Excision Following Plutonium-contaminated Wounds: Inferences from Historical Cases

2023

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“…With regard to wound contamination, excision of the wound site is often practiced and has indeed been employed in several cases of accidental contamination in man (Bailey et al, 2003;Laroche et al, 2010;Schadilov et al, 2010;Sugarman et al, 2018;Klumpp et al, 2020). In general surgical removal of the contaminated site is combined with both local (washing of the wound) and intravenous DTPA.…”

Section: Data Availability Statementmentioning

confidence: 99%

“…Cases of actinide contamination by inhalation have been reported since the initial use of compounds for either military devices or nuclear fuels (Carbaugh and La Bone, 2003;Okladnikova et al, 2005;Grappin et al, 2007). Similarly, accidental entry of actinides following wounding has also been reported (Ilyin, 2001;Falk et al, 2006;James et al, 2007;Sugarman et al, 2018;Klumpp et al, 2020). Indeed, case reports of incidents/accidents, biological assay data and tissues have been collated by registries in several countries (Loffredo et al, 2017;Kathren and Tolmachev, 2019) that provide a valuable source of information.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Local and Systemic DTPA Treatment Efficacy According to Actinide Physicochemical Properties Following Lung or Wound Contamination in the Rat

2021

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Purpose: In cases of occupational accidents in nuclear facilities or subsequent to terrorist activities, the most likely routes of internal contamination with alpha-particle emitting actinides, such as plutonium (Pu) and americium (Am), are by inhalation or following wounding. Following contamination, actinide transfer to the circulation and subsequent deposition in skeleton and liver depends primarily on the physicochemical nature of the compound. The treatment remit following internal contamination is to decrease actinide retention and in consequence potential health risks, both at the contamination site and in systemic retention organs as well as to promote elimination. The only approved drug for decorporation of Pu and Am is the metal chelator diethylenetriaminepentaacetic acid (DTPA). However, a limited efficacy of DTPA has been reported following contamination with insoluble actinides, irrespective of the contamination route. The objectives of this work are to evaluate the efficacy of prompt local and/or systemic DTPA treatment regimens following lung or wound contamination by actinides with differing solubility. The conclusions are drawn from retrospective analysis of experimental studies carried out over 10 years.Materials and Methods: Rat lungs or wounds were contaminated either with poorly soluble Mixed OXide (U, Pu O2) or more soluble forms of Pu (nitrate or citrate). DTPA treatment was administered promptly after contamination, locally to lungs by insufflation of a powder or inhalation of aerosolized solution or by injection directly into the wound site. Intravenous injections of DTPA were given either once or repeated in combination with the local treatment. Doses ranged from 1 to 30 µmol/kg. Animals were euthanized from day 7–21 and alpha activity levels were measured in urine, lungs, wound, bone and liver for determination of decorporation efficacy.Results: Different experiments confirmed that whatever the route of contamination, most of the activity is retained at the entry site after insoluble MOX contamination as compared with contamination with more soluble forms which results in very low activities reaching the systemic compartment and subsequent retention in bone and liver. Several DTPA treatment regimens were evaluated that had no significant effect on either lung or wound levels compared with untreated animals. In contrast, in all cases systemic retention (skeleton and liver) was reduced and urinary excretion were enhanced irrespective of the contamination route or DTPA treatment regimen.Conclusion: The present study demonstrates that despite limitation of retention in systemic organs, different DTPA protocols were ineffective in removing insoluble actinides deposited in lungs or wound site. For moderately soluble actinides, local or intravenous DTPA treatment reduced activity levels both at contamination and at systemic sites.

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“…However, there are no formal protocols or recommendations for managing the emotional needs in this circumstance. In some cases, treatment decisions regarding chelation and excision may be affected by a patient's mental state (e.g., a patient who wants treatment in order to gain a feeling of control over the situation) and vice versa (e.g., a patient feeling less anxious because treatment appears to be effective) (Klumpp et al 2018(Klumpp et al , 2020. A literature review reveals that there have been no published peer-reviewed studies on the mental health of workers who have had plutonium intakes.…”

Section: Introductionmentioning

confidence: 99%

“…There are also anecdotal reports suggesting that some psychological adverse effects, which persist many months or years after treatment, may have been associated with chelation therapy. 2 Finally, a recent case study of a contaminated wound reported alarming adverse psychological events that medical providers attributed to chelation with DTPA (Klumpp et al 2020).…”

Section: Introductionmentioning

confidence: 99%

Side Effects and Complications Associated with Treating Plutonium Intakes: A Retrospective Review of the Medical Records of LANL Employees Treated for Plutonium Intakes, with Supplementary Interviews

et al. 2022

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Anecdotal evidence indicates there may be unpublished physical and psychological events associated with the medical treatment of plutonium intakes. A thorough review was conducted of the medical and bioassay records of current and previous Los Alamos National Laboratory (LANL) employees who had experienced plutonium intakes via wound or inhalation. After finding relatively incomplete information in the medical records, the research team interviewed current LANL employees who had undergone chelation therapy and/or surgical excision. Although the dataset is not large enough to reach statistically significant conclusions, it was observed that adverse events associated with treatment appear to be more frequent and more severe than previously reported.

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Response to a Skin Puncture Contaminated with 238Pu at Los Alamos National Laboratory

Cited by 4 publications

References 15 publications

Effectiveness of Surgical Excision Following Plutonium-contaminated Wounds: Inferences from Historical Cases

Effectiveness of Surgical Excision Following Plutonium-contaminated Wounds: Inferences from Historical Cases

Comparison of Local and Systemic DTPA Treatment Efficacy According to Actinide Physicochemical Properties Following Lung or Wound Contamination in the Rat

Side Effects and Complications Associated with Treating Plutonium Intakes: A Retrospective Review of the Medical Records of LANL Employees Treated for Plutonium Intakes, with Supplementary Interviews

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