Polonium
OVERVIEW
- the radioactive isotope polonium-210 was implicated in the death of former KGB/ FSB operative Alexander Litvenko
- also has potential for use in nuclear terrorism as a ‘dirty bomb’
TOXICODYNAMICS
- polonium-210 is an alpha emitter, it does not produce gamma radiation
- low tissue penetration (radiation will not penetrate paper or skin)
- alpha particles cause direct molecular damage to DNA and other cellular components
TOXICOKINETICS
- must be administered systemically to be toxic (ingestion, inhalation or injection)
- causes whole body exposure proportional to blood flow
- does not localised to specific organs
- radioactive half life is 138 days
- biological half life is 50 days (slow elimination from tissues)
CLINICAL MANIFESTATIONS
- mimics acute radiation sickness
- <24 hours: GI symptoms such as nausea, vomiting, diarrhea
- days: pancytopenia; GI ulceration, necrosis and haemorrhage
- complicated by overwhelming sepsis and MODS
INVESTIGATIONS
- paracetamol, ECG, blood gas
- FBC, UEC, CaMgPO4, coags, lipase, Trop, CK (guided by presentation)
- septic screen
- alpha particles are not detected by Geiger counters — polonium-210 is hard to detect!
MANAGEMENT
- resuscitation
- decontamination
- consider BAL chelation likely to be increasingly less effective with time since exposure)
- treat sepsis
- treat pancytopenia — blood products, G-CSF
- organ support for MODS
Public health measures
- notification
- contact tracing
References and Links
CCC Toxicology Series
General
Approach to acute poisoning, ECGs in Tox, Evidenced-based Tox, Toxicology literature summaries, Does anti-venom work?
Toxins / Overdose
Amphetamines, Barbituates, Benzylpiperazine, Beta Blockers, Calcium Channel Blocker, Carbamazepine, Carbon Monoxide, Ciguatera, Citrate, Clenbuterol, Cocaine, Corrosive ingestion, Cyanide, Digoxin, Ethanol, Ethylene Glycol, Iron, Isoniazid, Lithium, Local anaesthetic, Methanol, Monoamine oxidase inhibitor (MAOI), Mushrooms (non-hallucinogenic), Opioids, Organophosphate, Paracetamol, Paraquat, Plants, Polonium, Salicylate, Scombroid, Sodium channel blockers, Sodium valproate, Theophylline, Toxic alcohols, Tricyclic antidepressants (TCA)
Envenomation
Marine, Snakebite, Spider, Tick paralysis
Syndromes
Alcohol withdrawal, Anticholinergic syndrome, Cholinergic syndrome, Drug withdrawals in ICU, Hyperthermia associated toxidromes, Malignant hyperthermia (MH), Neuroleptic malignant syndrome (NMS), Opioid withdrawal, Propofol Infusion Syndrome (PrIS) Sedative toxidrome, Serotonin syndrome, Sympatholytic toxidrome, Sympathomimetic toxidrome
Decontamination
Activated Charcoal, Gastric lavage, GI Decontamination
Enhanced Elimination
Enhanced elimination, Hyperbaric therapy for CO
Antidotes
Antidote summary, Digibind, Glucagon, Flumazenil, HIET – High dose euglycaemic therapy, Intralipid, Methylene Blue, N-Acetylcysteine (NAC), Naloxone
Miscellaneous
Cocaine chest pain, Digoxin and stone heart theory, Hyperbaric oxygen, Hypoxaemia in tox, Liver failure in tox, Liver transplant for paracetamol, Methaemoglobinaemia, Urine drug screen
- Gussow, L. Five Things Every Toxicologist Should Know About Polonium. Emergency Medicine News; Feb 2007; 29(2)p22 doi: 10.1097/01.EEM.0000264918.11267.01
- Jefferson RD, Goans RE, Blain PG, Thomas SH. Diagnosis and treatment of polonium poisoning. Clin Toxicol (Phila). 2009 May;47(5):379-92. doi: 10.1080/15563650902956431. Review. Erratum in: Clin Toxicol (Phila). 2009 Jul;47(6):608. PMID: 19492929.
- Nemhauser JB. The polonium-210 public health assessment: the need for medical toxicology expertise in radiation terrorism events. J Med Toxicol. 2010 Sep;6(3):355-9. PMC3550481.
- MATTER — Storr, W. Bad Blood: The Life and Death of Alexander Litvenko (2013)
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
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