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

  • 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)

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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