“Chornobyl” First Aid Kit

The recurrence of the Chornobyl tragedy is an event with almost zero probability today. This is primarily due to the operation of another more protected reactor type in Ukraine, as well as due to changes in NPP operation algorithms and safety systems that reached a fundamentally new quality level during 33 years after the Chornobyl accident. Nevertheless, never say “never”, and it is better to arm yourself with knowledge in advance than to be not ready for a situation when the time for rescue is reckoned in minutes.

One of the frequently asked questions that are difficult to answer in plain language: what measures should be taken after all? Summing up the topic of the Chornobyl disaster that has stirred up the public, we present a rating of available (and not quite available) antidotes capable of triggering during a radiation release.

You should remember that it is impossible to protect yourself in advance, so the below mentioned is ineffective and cannot be used as a preventive measure.

Radionuclide contamination occurs through:

• movement of air masses with radioactive dust,
• radioactive precipitations,
• intake with foodstuff that has been grown in the territories affected by the first two items.

In cities, the min part of hazardous substances will accumulate on flat surface areas: lawns, roads, roofs. As for agricultural land, radioactive substances will precipitate on the leaves of plants and on the grass, and then migrate to herbivores. Radionuclides gradually enter the soil with rainwater from the leaves or with fallen leaves; they accumulate there and slowly but steadily enter agricultural plants through the root system. It is clear that the main radionuclide accumulator is forest. Due to the constant circulation of certain radionuclides (without becoming insoluble), the contamination levels of forest products (mushrooms, berries and game) remain quite high for a long time after release. The same regularity retains for drainless lakes (and for fish in them).

Accordingly, domestic measures to mitigate radiation can be divided into two main areas:

1. prevent contamination with short-lived isotopes, during which radioiodine iodine (half-life is eight days) and tellurium are the most dangerous;
2. combat radionuclides accumulated in water/soil/food with a half-life of about 30 years.

The radioactive isotopes of plutonium and americium can stay in the soil for hundreds, and possibly thousands of years, but their amount is small and can be neglected.

Combatting short-lived isotopes

The main short-lived isotope affecting the thyroid gland is iodine-131. As known, iodine has the property of excellent sublimation (it immediately passes from the solid form to gas) and spreads by the wind in a volatile aerosol form. The main threat from this isotope exists during one week after the accident (therefore, prompt notification is of great importance!). The best antidote is stable iodine in the form of potassium iodide tablets. Iodine accumulates very unevenly in the body, about half of it remains in the thyroid gland. Therefore, it is necessary to saturate the body with stable safe iodine for prophylactic purposes and not to give a single chance to radioactive iodine. The most practical option are potassium iodide tablets. The analogue is iodomarin medicine that can be used to prevent accumulation in the thyroid gland by both radioactive iodine inhalation and its entering into the digestive tract. 

Traditional prophylactic dosage is 125 mg for adults and children over 2 years old (40 mg for children under 2 years old). 5% alcohol iodine solution or Lugol solution is allowed in the absence of the tablet form. Adults and adolescents over 14 years old take 40 drops of 5% iodine solution (20 drops twice a day) or 20 drops of Lugol’s solution (10 drops twice a day) per day. For children over 5 years old, 20 drops of 5% iodine solution (10 drops twice a day) or 10 drops of Lugol solution (5 drops twice a day) per day. Alcohol iodine solution and Lugol’s solution is not for internal use for children under 5 years old. Iodine prophylaxis for them is applying a swab with alcohol iodine solution by painting iodine grid and stripes on the skin of the forearm or lower leg (better use 2.5% solution in view of possible burns) in the following doses: 20 drops a day for children from 2 to 5 years old, and 10 drops a day on the skin for children under 2 years old.

The recommended potassium iodide dose of 125 mg exceeds the daily need of the body for a microelement such as iodine by 1000. The protective effect is observed due to the pharmacological blockade of the synthesis of thyroxin in the thyroid gland. The mentioned dose of iodine ions up to 99.5% eliminates the penetration of radioactive iodine-131 into the thyroid gland (the reaction is observed already in 5 minutes after taking a potassium iodide tablet on an empty stomach and in 30 minutes after taking it on a full stomach. The effectiveness of iodine prophylaxis is quite high (90-100%) when taking iodine medicine before inhalation of radioactive iodine aerosols or within 30 minutes after it. The effectiveness of iodine prophylaxis sharply decreases (by 1/3) in two hours after radioactive iodine entering into the body, and every other day it does not affect the radiation dose accumulation resulting from the previous incorporation of radioactive iodine. A delay in iodine prophylaxis for more than 6 hours after the fallout of radioactive precipitations essentially limits its effectiveness, and every other day its advisability is even doubtful. That is why the speed of public notification is vital. Every minute of delay is someone’s agonizing illness/death in the direct sense of the word.

Iodine medicine should be used until disappearance of the threat related to entering of radioactive isotopes of iodine into the body. However, one should note that a conditioned reflex has been already developed in the mass consciousness of the public: they immediately buy iodine in pharmacies at first reference to radiation. This does not make much sense; it is enough to have the required amount of it for all family members only for one week. Taking into account the above paragraph, too late to worry, if the intake is delayed.

Anyway, iodine is still a halogen and can cause serious poisoning during an overdose. The best option is potassium iodide tablets/powder. In addition to useful iodide, iodine tincture contains molecular iodine that should pass into ions before being absorbed. Therefore, a good option in the absence of pure KI is to “extinguish” the measured amount of iodine tincture by sodium thiosulfate solution before bleaching, and then use it.

Glucosinolates such as spicy, horseradish, mustard, etc., prevent iodine absorption thereby suppressing the function of the thyroid gland; therefore, they are considered goitrogens (or goitrogenic substances, that is, the substances that cause the formation of goiter).

Thus, in the most extreme case, if you can’t find iodine medicine, you can either eat foods with a high iodine content (seaweed, cod and its liver, shrimps, tuna, prunes, feijoa, persimmon) or goitrogen-containing products blocking iodine entrance into the thyroid gland at all (soy, broccoli).

Combating long-lived isotopes

The most frightful long-lived isotopes can be considered cesium-137 and strontium-90. Cesium-137 is present in releases during an accident at any nuclear facility from Chornobyl and Fukushima to some hypothetical dirty bomb anywhere.

The antidote to cesium-137 ingested with food and water is a mixture of potassium hexacyanoferrates (II) such as Prussian blue (“ferrocyanide”). It binds cesium ingested with food and/or water into the digestive tract and does not allow it to be absorbed into the blood and enter the body. As a result, almost 100% of cesium-137 passes through the digestive tract without stopping. Ferrocyanide tablets can help here (initially positioned as a sorbent of radioactive cesium), which could be still found after the Chornobyl disaster, and then suddenly it became difficult. In the extreme case, you can look for a veterinary drug Bifezh for animals inhabiting the radionuclide-contaminated territories. As an emergency option, you can eat a watercolor paint in which Prussian blue is used as a blue pigment. Make a note that yellow blood salt E536 is food additive that can be added, for example, to black sea sprat in tomato sauce, that is, this can be quite legally purchased in stores selling food additives.

Application: the recommended dose is 1 g of ferrocyanide 3 times a day “in case of a threat or actual entrance of cesium, rubidium radioisotopes and other fission products of transuranium elements into the body, and if it is impossible to exclude radioactive cesium ingestion into the digestive tract with water or food”. The medicine reduces the half-life of radioactive cesium in the human body by 2-4 times when it is taken orally (1 g 3 times a day) every day during 2-4 weeks.

Radiogardase (Germany) is a foreign analogue of ferocin-containing preparations. Potassium acetate that can be obtained by neutralizing potassium alkali (or some potash from ash) by acetic acid can also be the contact antidote-detoxicant of cesium-137. It is recommended to take 1 tablespoon of 15% solution 5 times a day.

Polysurmine is also worth mentioning among the medicine for humans to remove strontium isotopes, above all, strontium-90 whose half-life (slightly less than 30 years) and release fraction during nuclear fuel fission, that is, its amount in the reactor is similar with cesium -137. These two factors explain why in addition to the maps of territories contaminated resulting from the Chornobyl accident there are similar maps of strontium contamination. The mentioned antidote also cannot be found in pharmacies. In fact, it is an antimony-silicon cationite obtained by the reaction of antimony chloride (V) with calcium silicate. The main difficulty is the search for antimony chloride, since the component is quite active and rare. Calcium silicate is also used in the construction of fireplaces. (Promasil, Silca) or as a filler in the production of building materials. In addition, the natural mineral wollastonite is almost pure calcium silicate. If you managed to synthesize/get/buy it, it is necessary to use it according to the following method. Take a dose of 4 g in 0.5 glass of water with food 3 times a day during 7 days.

In addition to polysurmin, one can mention adsobar or barium sulfate with recommended dose of 30 g/glass of water. This enterosorbent is prescribed in threat or actual ingestion of strontium radioisotope. This enterosorbent is widely used as radiopaque substance in X-ray examination of the digestion tract. The patient takes a suspension of barium sulfate (“barite porridge”) with barium content of 58.7% for radiographic examination of the digestive organs. This substance was added to Lego products in the 1990s to provide radiopacity in case a child swallows a part. However, the experiment was unsuccessful due to a decrease in the strength of parts.

Barium sulfate intake regime: the medicine is effective when used prophylactically 1–2 hours before radionuclide entrance and as emergency aid in the next few hours after radionuclide entrance. It should be applied by ingestion once in a dose of 25 g of powder that is previously mixed in a glass of water. In using the medicine as an emergency aid in case of radionuclide poisoning, it is prescribed together with laxatives (magnesium sulfate ~ magnesia or sodium sulfate ~ glauber’s salt of 25 g).

In addition to the aforementioned enterosorbent, sodium alginate (Algisorb enterosorbent = calcium alginate) can be used to remove both cesium and strontium from the body. This reagent is registered in the food industry as E401 food additive and is used as a thickening agent and stabilizer.

Application: protective effect of alginate in a human body in a dose of 20 g with respect to radioactive strontium is 90%. It should be ingested with food in a dose of 5 g 3 times a day. In acute poisoning with radioactive strontium, the dose increases to 20 g.

If sodium alginate could not be found, look for pectin (often sold with spices). As an enterosorbent (suspension in water), it is applied in the dose of 5 g 3 times a day. The most extreme option is candied fruit (orange peel is cooked in sugar syrup with following addition of citric acid according to your to taste). The dose is similar to pectin (bigger is better since it is actually a natural material).

Natural zeolites and bentonites can selectively remove radionuclides and retain ion-exchange properties under high radioactivity. Selective sorption by natural zeolites is in the following decreasing order: 90Sr > 137Cs > 60Со> 45Са. Therefore, it makes sense to buy a bentonite clumping filler instead of sawdust for cats. Should anything happen, its dual purpose will work.

Bentonite MUST NOT be ingested (this is due to the ability of these clays to swell in a humid environment); it is better to use it in cooking with products. You can ingest zeolites (molecular sieves), which also have enterosorption properties; by the way, they are widely used in animal feed for this purpose.

Broad-spectrum complexing agents/radioprotectors

Different complexing agents (DTPA, EDTA, etc.) are used as substances that accelerate radionuclide elimination without a clearly defined specificity. That is, at least Trilon-B packaging should always be available at home. The component is inexpensive and widely available. We can mention pentacin, which cannot be found everywhere; it is also calcium trisodium pentetate and Ca-DTPA (pentetate calcium trisodium). This reagent is an excellent complexing agent, it accelerates the excretion of plutonium, yttrium, cerium, zinc, cadmium, cobalt, manganese and lead from the body including their radioactive isotopes. You can also recall unitiol that is used in case of poisoning with compounds of mercury, arsenic, chromium and other ‘thiol poisons”. Unitiol forms complexes including the ones with radioactive polonium (“the Litvinenko case”). The medicine (5% solution) is administered intramuscularly in an amount of 5-10 ml (1 ml of 5% solution per 10 kg of patient weight) every 6-8 hours (3-4 injections per day) on the first day, 2-3 injections each 9-12 hours on the second day, and 1-2 injections per day during the following days.

A legendary medicine such as cystamine is also indirectly related to unitiol (due to functional groups with sulfur). Acetylcysteine used as a cough remedy can be proposed instead of it.

“Big guns” may include radio protectors, i.e., substances providing chemical protection against radiation. The fastest radioprotectors are pharmaceuticals with vasoconstrictor properties. The first thing to mention is the so-called “B-190 preparation”, a medicine for emergency medical protection in case of external radiation exposure. Indralin, i.e., imidazole derivative, agonist of a-adrenoreactive body structures that was produced to replace it is intended for use in extreme situations accompanied by the threat of exposure in doses over 1 Gy to reduce the severity of acute radiation harm to the body. The medicine prescribed for ingestion in a dose of 0.45 g (3 tablets, 0.15 g each) 10-15 minutes before the intended exposure. The duration of radioprotector is about 1 hour. It is almost impossible to find it. Another effective radioprotector of imidazoline group is naphthyzine. It is used in a volume of 1 ml 3-5 minutes before the intended exposure. However, it can be found in our pharmacies more often in a form of usual nasal drops.

In addition, there is one peculiarity. The use of radioprotectors for short-term exposure in doses below 1 Gy is inadvisable due to the absence of a practically significant anti-radiation effect under these conditions.

Protective pharmaceuticals also include drugs that increase the body’s radiation resistance due to the ability to increase the so-called “endogenous radiation resistance background” for a sufficiently long period. The drugs of this group can change the ratio of “endogenous” (internal biological) radioprotectors (biogenic amines, non-protein thiols and other components of the antioxidant system, corticosteroids) and endogenous “radiosensitizers” (lipid peroxidation products and other prooxidants) in favor of “radioprotectors”. This includes vitamins, (plant and animal) adaptogens and such a usual thing as riboxin. It was used to increase the radio resistance of the participants in Chernobyl accident mitigation. Vitamins and vitamin-amino-acid complexes (which will be at hand) may be also used to prevent the adverse effects of non-lethal exposure doses. Deoxinate is a salt of deoxyribonucleic acid (sodium deoxyribonucleate), it is recommended for use in the early treatment of radiation harm. This compound refers to tissue metabolism correctors (together with pyrimidine, adenosine and hypoxanthine derivatives). Most of these compounds belong to the natural metabolites required for biosynthesis of ATP and nucleic acids or speed up restoration of DNA chains damaged by radiation. Deoxinate is used not later than 24 hours after irradiation as an early treatment: it is injected once intramuscularly or subcutaneously in a volume of 15 ml (75 mg of active substance).

Propolis among zoopreparations (I recalled also protein hydrolysates from hydrobionts such as mussels, rapans, squid, scallops that support body’s radio-resistance: MIGI-K preparations such as Lateren, Rapanin, Kalmarin, Gremarin”, etc.) and eleutherococcus extract and ginseng tincture among plant adaptogens have the highest radioprotective activity. In conditions of increased radiation background, the drugs are administered during 14-21 day courses with breaks for 2-3 weeks, 20-30 drops should be taken 30 minutes before meals 3 times a day. The prophylactic use of adaptogens is envisaged in doses below the therapeutic ones: it is necessary to take a few drops of tincture or extract once a day (in the morning). The drugs are well accepted in low doses. Side effects of the drugs include increased blood pressure, increased irritability, and insomnia.

Does vodka/alcohol help with radiation? It does not help, although it can effect as radioprotector along with the substances such as cyanides (!), nitrites, narcotic agents, sleeping pills and tranquilizers. The mechanism is related to the ability to cause hypoxia (oxygen starvation) in the body’s organelles (but not due to blocking of cellular receptors as some histamine/acetylcholine or “combat antidotes” such as β-mercaptoethylamines and related sulfur-containing preparations). Red dry wine containing considerable doses of antioxidants will be much more effective as an adaptogen to reduce the effect of water radiolysis (etc. processes occurring in an irradiated body).

According to HABR