Safety Information

Medical Emergency Response to Radiologic Incidents

Posted: August 19th, 2004
Source: Carol S. Marcus, PhD, MD Prof. of Radiation Oncology and of Radiological Sciences, UCLA - California Disaster Medical Assistance Team-9 (DMAT CA-9) - Western National Medical Response Team (WNMRT) - and Los Angeles County Dept. of Health Services Emergency Medical Services Agency

The possibility of radiologic accidents involving unsealed radioactive material is always present where radioactive materials are used. Such incidents are relatively unusual in the United States, where we take significant care to avoid them. When they do occur, they usually affect one or a few radiation workers, often in a controlled environment in which sophisticated expertise, materials and equipment are available for diagnosis and treatment. For this reason, most American physicians, including nuclear medicine physicians, radiologists, and emergency medicine physicians, have little or no education or experience with the medical management of internally contaminated individuals.

The possibility of terrorist acts involving radioactive material means that physicians who normally would never have occasion to treat internally contaminated patients might be called upon to do so. The purpose of this presentation is to review the detailed use of a number of drugs and procedures that will eliminate some or most internal radioactive contamination from the body.

Please see the .pdf file below for the full text on this issue.

Adverse Reactions Table

The overall prevalence of adverse reactions from radiopharmaceuticals has been documented at 2.3/100,000 adminstrations. Many of the adverse reactions listed below were obtained from clinical trials which were not placebo-controlled and may have no causative relation with the radiopharmaceutical. Nevertheless each has been noted and reported to the manufacturer, the SNM, USP, and/ or FDA and therefore is believed at least worthy of mention. Causality is not implied.

Pharmacopeia Committee of the SNM

NOTE: A printable .PDF file version of this table is available in the related items box at the bottom of this page.

Radiopharmaceutical	Trade Name	Side Effects, Comments & Other Reactions
^{57Co-cyanocobalamin}	Rubratope-57, Dicopac kit	None.
⁵¹Cr-sodium chromate	Chromitope	erythema, flushing, hypertension, tachycardia and diaphoresis.
¹⁸F-fludeoxyglucose,FDG, fluorodeoxyglucose		None.
⁵⁹Fe-ferrous citrate		None.
⁶⁷Ga-gallium citrate	Neoscan	nausea, vomiting, erythema, flushing, diffuse rash, pruritus, hives/urticaria, respiratory reaction, tachycardia, syncope or faintness, dizziness, vertigo, facial swelling, metallic taste, dyspnea, salty taste.
¹¹¹In-capromab pendetide	ProstaScint	increase in bilirubin, hypotension, hypertension, injection site reactions, elevated liver enzymes (could be due to tumor), pruritus, fever, rash, headache, myalgia, asthenia, burning sensation in thigh, shortness of breath, alterations of taste, production of HAMA by the recipient.
¹¹¹In-indium oxyquinoline, Oxine		fever, diffuse rash, pruritus and hives/urticaria.
^{111In-pentetate DTPA}	MPI-DTPA	fever, nausea, vomiting, erythema, flushing, pruritus, hives/urticaria, cardiac arrest, hypertension, headache, aseptic meningitis; one death 20 min postinjection.
^{111In-pentetreotide}	Octreoscan	fever, nausea, erythema, flushing, hypotension, bradycardia, dizziness, vertigo, headache, diaphoresis, arthralgia and asthenia, one case of anemia.
^{111In-satumomab pendetide}	OncoScint CR/OV	chills, fever, nausea, erythema, flushing, diffuse rash, pruritus, chest pain, tightness or heaviness, hypertension, hypotension, dizziness, vertigo, headache, diaphoresis, arthralgia and asthenia, confusion, diarrhea, hypothermia, bradycardia, vasodilatation,angioedema, production of HAMA by the recipient.
¹²³I-iobenguane metaiodobenzylguanidine, MIBG		nausea, erythema, flushing, hypertension, respiratory reaction, syncope or faintness, dizziness and vertigo, tachypnea.
¹²³I-iodohippurate sodium	Nephroflow, Nephropure	nausea, vomiting, diffuse rash, pruritus, hives/urticaria and hypotension.
¹²³I-sodium iodide		nausea, vomiting, diffuse rash, pruritus, hives/urticaria, chest pain, tightness or heaviness, respiratory reaction, tachycardia, syncope or faintness and headache, tachypnea; parosmia.
¹²⁵I-iodinated albumin (IHSA, iodinated human serum albumin)		diffuse rash.
¹²⁵I-sodium iothalamate	Glofil	None.
¹³¹I-iobenguane metaiodobenzylguanidine, MIBG		erythema, flushing, diaphoresis and metallic taste, tingling of arms and face.
¹³¹I-iodinated albumin	RISA, Radioinated serum, albumin, Megatope	None.
¹³¹I-iodohippurate sodium	Hipputope, Hippuran	nausea, vomiting, pruritus hives/urticaria, hypertension, respiratory reaction, tachycardia, syncope or faintness, diaphoresis, anaphylaxis, facial swelling, dyspnea; "cold sweat", pallor; amaurosis fugax.
¹³¹I-sodium iodide	Iodotope	chills, nausea, vomiting, pruritus, hives/urticaria, chest pain, tightness or heaviness, tachycardia, headache, dizziness.
^{131I-6-beta iodomethyl-18-norcholesterol}	NP-59	nausea, vomiting, erythema, flushing, chest pain, tightness or heaviness, hypertension, respiratory reaction, tachycardia, dizziness, headaches, diaphoresis, facial swelling, abdominal pain, metallic taste, frozen tongue, dyspnea.
^{81mKr-krypton}		None.
^13N-ammonia		None.
^{32P-chromic phosphate suspension}	Phosphocol	chills, fever, nausea, vomiting, chest pain, tightness or heaviness, respiratory reaction, abdominal pain, dyspnea, sore throat, cough, pleuritis, myelosuppression.
^{32P-sodium phosphate}		myelosuppression, bone pain from the flare phenomenon.
^{82Rb-rubidium}		None.
^{153Sm-lexidronam}	Quadramet	myelosuppression, bone pain from the flare phenomenon.
^{89Sr-strontium chloride}	Metastron	chills, fever, myelosuppression, bone pain from the flare phenomenon.
^{99mTc-albumin colloid}	Microlite	chills, nausea, erythema, flushing, diffuse rash, pruritus, hypertension, hypotension, respiratory reaction, tachycardia, dizziness, vertigo, diaphoresis, anaphylaxis, abdominal pain, myelosuppression (injectate also included MDP and soluble albumin for cases with anaphylaxis).
^{99mTc-albumin (HSA, human serum, albumin)}		chills, fever, erythema, flushing, diffuse rash, hypotension, tachycardia, dizziness, vertigo, facial swelling, tachypnea, malaise, dyspnea.
^{99mTc-arcitumomab}	CEA-Scan	transient eosinophilia, nausea, bursitis, urticaria, pruritus, headache, nausea, fever, one grand mal seizure, HAMA production by the recipient.
^{99mTc-bicisate dihydrochloride (ethyl cysteinate dimer, ECD)}	Neurolite	nausea, diffuse rash, chest pain, tightness or heaviness, respiratory reaction, seizures, syncope or faintness, dizziness, vertigo, headache, cyanosis and asthenia, neurologic adverse events may have been related to underlying disease, including hallucinations, parosmia, also cardiac failure; respiratory arrest.
^{99mTc-disofenin}	Hepatolite	None.
^{99mTc-exametazime (hexamethylpropylene amine oxine, HMPAO)}	Ceretec	fever, erythema, flushing, diffuse rash, hypertension, hypotension, respiratory reaction, seizures, diaphoresis, cyanosis, anaphylaxis, facial swelling, abdominal pain, dyspnea with myoclonus (labeled WBC).
^{99mTc-gluceptate}	Glucoscan, Technescan, Gluceptate	chills, nausea, erythema, flushing, diffuse rash, hives/urticaria, respiratory reaction, tachycardia, seizures, dizziness, vertigo, headache, diaphoresis.
^{99mTc-lidofenin}	Technescan HIDA	chills, nausea.
^{99mTc-macroaggregated albumin (MAA)}	AN-MAA, Macrotec, MPI-MAA, Pulmolite, Technescan MAA	chills, nausea, erythema, flushing, diffuse rash, pruritus, hives/urticaria, cardiac arrest, chest pain, tightness or heaviness, hypertension, hypotension, respiratory reaction, tachycardia, syncope or faintness, diaphoresis, cyanosis, anaphylaxis, metallic taste, dyspnea; throat tightness; arm numbness; parosmia.
^{99mTc-mebrofenin}	Choletec	hives/urticaria.
^{99mTc-medronate (MDP, methylene diphosphonate)}	Osteolite, Technescan, MDP, AN-MDP, MPI-MDP	chills, fever, nausea, vomiting, erythema, flushing, diffuse rash, pruritus, hives/urticaria, cardiac arrest, chest pain, tightness or heaviness, hypertension, hypotension, respiratory reaction, tachycardia, seizures, syncope or faintness, dizziness, vertigo, headache, diaphoresis, anaphylaxis, abdominal pain, metallic taste, asthenia, pain/burning at inj. site, photophobia, one death secondary to cardiac arrhythmia.
^{99mTc-mertiatide (MAG3, mercaptoacetyl-glyclyglyclyglycine)}	Technescan MAG3	nausea, vomiting, erythema, flushing, syncope or faintness, sore, thick throat.
^{99mTc-oxidronate (HDP, hydroxymethylene diphosphonate)}	Osteoscan-HDP	nausea, vomiting, erythema, flushing, diffuse rash, pruritus, chest pain, tightness or heaviness, heartburn, seizures, diaphoresis, facial swelling.
^{99mTc-pentetate (DTPA, diethylenetriaminepentaacetic acid)}	Technescan DTPA, AN DTPA, MPI-DTPA, Techniplex	chills, nausea, erythema, flushing, diffuse rash, pruritus, hives/urticaria, hypertension, hypotension, respiratory reaction, tachycardia, syncope or faintness, headache, cyanosis, anaphylaxis, arthralgia, pain, burning at inj. site, cough; wheezing; trisodium salt can cause neurologic signs if given inthrathecally.
^{99mTc-pyrophosphate (PYP) and Sodium Pyrophosphate)}	Pyrolite, Technescan PYP, Phosphotec, MPI, Pyrophosphate, AN Pyrotec, Ultratag	chills, fever, nausea, vomiting, erythema, flushing, diffuse rash, pruritus, hives/urticaria, chest pain, tightness or heaviness, hypotension, respiratory reaction, syncope or faintness, dizziness, vertigo, pain/burning at inj. site, tinnitus.
^{99mTc-sestamibi}	Cardiolite, Mirluma	nausea, erythema, flushing, diffuse rash, pruritus, seizures, headache, metallic taste, tingling.
^{99mTc-sodium pertechnetate}	Minitec, UltratecKow	chills, nausea, vomiting, diffuse rash, pruritus, hives/urticaria, chest pain, tightness or heaviness, hypertension, dizziness, vertigo, headache, diaphoresis, anaphylaxis.
^{99mTc-succimer (DMSA, dimercaptosuccinic acid)}	MPI-DMSA, Nephroscint	nausea erythema, flushing, syncope or faintness, abdominal pain.
^{99mTc-sulfur colloid}	AN-Sulfur Colloid, TechneColl, TcSC, Tesuloid	chills, fever, nausea, vomiting, erythema, flushing, diffuse rash, pruritus, hives/urticaria, cardiac arrest, chest pain, tightness or heaviness, hypertension, hypotension, respiratory reaction, tachycardia, bradycardia, seizures, syncope or faintness, dizziness, vertigo, headache, diaphoresis, cyanosis, anaphylaxis, arthralgia, pain/burning at inj. site, wheezing, dyspnea, choking; sneezing, itchy throat, parasthesia, weakness.
^99mTc-tetrofosmin	Myoview	angina, hypertension, Torsades de Pointes (these three probably occurred because of underlying heart disease); vomiting, abdominal discomfort, cutaneous allergy, hypotension, dyspnea,metallic taste, burning of mouth, unusual odor, mild leukocytosis.
²⁰¹Tl-thallous chloride		fever, erythema, flushing, diffuse rash, pruritus, hypotension.
^127Xe-xenon		None.
^133Xe-xenon		None.

This table was originally printed in J. Nuclear Med. 1996;37:185-192;1064-1067.

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