What is the appropriate treatment for a patient who has consumed shrimp contaminated with cesium 137?

Management of Cesium-137 Contaminated Shrimp Ingestion

For a patient who has consumed cesium-137 contaminated shrimp, immediately remove all contaminated clothing, contact the Poison Control Center (1-800-222-1222) for specific guidance, and activate EMS if the patient exhibits any signs of radiation sickness such as nausea, vomiting, altered mental status, or difficulty breathing. 1, 2

Immediate Decontamination and Assessment

External Decontamination

• Remove all contaminated clothing and shoes immediately, which accomplishes 70-95% of decontamination 2
• Irrigate any exposed skin with copious amounts of running water for at least 15 minutes 2
• Remove contaminated jewelry and personal items 2
• Healthcare staff must wear appropriate personal protective equipment during all decontamination procedures 2

Internal Contamination Management

• Do NOT administer anything by mouth including water, milk, or activated charcoal unless specifically directed by Poison Control 1, 3
• Do NOT induce vomiting, as there is no evidence this provides clinical benefit and may cause harm 1, 3
• Contact the Poison Control Center immediately at 1-800-222-1222 for specific guidance on cesium-137 ingestion management 1, 2

The rationale for avoiding oral administration is critical: human studies have failed to demonstrate clinical benefit from dilution attempts, and such interventions may cause emesis and aspiration 1. This differs from some chemical exposures where dilution might be considered.

Assessment of Radiation Exposure Severity

Clinical Indicators of Acute Radiation Syndrome

• Assess time to onset of vomiting (earlier onset indicates higher exposure) 2
• Monitor lymphocyte depletion kinetics 2
• Evaluate for presence of chromosome dicentrics 2

Important context: Cesium-137 behaves like potassium in the body and concentrates intracellularly, with approximately 86% eliminated through urine and 14% through feces via pancreatic and salivary gland secretion 4. The biological half-life allows for ongoing internal exposure even after the initial ingestion.

Supportive Care Based on Exposure Level

For Significant Radiation Exposure (>3 Gy whole-body or significant partial-body)

• Initiate colony-stimulating factors as soon as possible 2
• Administer broad-spectrum prophylactic antimicrobial agents including fluoroquinolones with streptococcal coverage for significant neutropenia 2
• Add antiviral and antifungal agents as needed 2
• Consider epoetin or darbepoetin for anemia 2
• Provide transfusion of leukoreduced and irradiated blood products for severe bone marrow damage 2

For Severe Exposure (7-10 Gy)

• Consider stem-cell transplantation in patients without significant burns or other major organ toxicity 2

General Supportive Measures

• Provide fluid resuscitation for burns, hypovolemia, or hypotension 2
• Administer antiemetic agents for nausea and vomiting 2
• Provide antidiarrheal agents for gastrointestinal symptoms 2
• Manage pain with appropriate analgesic agents 2
• Apply topical treatments for any burns 2
• Provide cardiac support and antiarrhythmic medications as needed for cardiac complications 2

Monitoring and Follow-up

• Perform regular complete blood counts with differential to monitor bone marrow function 2
• Assess risk to fetus in pregnant women 2
• Consider lower threshold (2 Gy) for initiating colony-stimulating factor therapy in children and elderly patients (>60 years) 2
• Provide psychological support for patients and families 2

Critical Pitfalls to Avoid

• Do not delay EMS activation while attempting home interventions 1, 3
• Do not delay decontamination while waiting for specialized equipment 2
• Do not use alcohol-based products on damaged skin 2
• Do not allow contaminated individuals to enter clean areas of healthcare facilities 2
• Do not administer anything by mouth without explicit direction from Poison Control 1, 3

Clinical context: Research demonstrates that cesium-137 concentrates particularly in the pancreas and can cause long-term metabolic disturbances 4, 5. However, the immediate priority remains managing acute radiation syndrome if present, preventing further contamination, and providing supportive care based on exposure severity.