Dynamic, equilibrium and human studies of adsorption of 201Tl by Prussian blue

Abstract

Prussian blue is the recommended but infrequently required antidote for radiocesium and thallium chemical poisoning. Conceivably, its most frequent application will be the decontamination of radiothallium (thallous chloride) from human body following myocardial scintigraphy. Dosage schedule and physicochemical parameters of interaction with radiothallium, however, need to be defined, as the known data is inadequate on this account. The objective of the present study is to create physiologically relevant and mathematically rigorous data on interaction of Prussian blue with Tl, to estimate dosage schedule of Prussian blue suitable for myocardial scintigraphy, and to perform preliminary human studies to evaluate the efficacy of the antidote in reducing the considerable radiation burden imparted by this radiotracer. Adsorption efficacy of Prussian blue for radiothallium was found to be more than 95% at basic (intestinal) pH even at low concentrations and in presence of the physiological cations, potassium and sodium. Isotherm analysis and derivations using Langmuir, Bajpai, Lagergreen, and Freundlich equations suggest a favorable adsorption of Tl on Prussian blue with qmax being 5,000 MBq g. Based on these findings and clinical considerations, particularly preferential gall bladder excretion and enterohepatic recycling of radioactive thallous chloride, a dose of 100 mg Prussian blue with every major meal for 3 days was considered adequate for the purpose. Our experience with the first two patients (serving as their own self-controls) suggests that Prussian blue therapy is a safe and effective method to significantly reduce radiation burden imparted by thallium myocardial scintigraphy.