Q: What is Potassium Iodide (KI)?
A: Potassium Iodide (chemical name 'KI') is much more familiar
to most than they might first expect. It is the ingredient added
to your table salt to make it iodized salt.
Potassium Iodide (KI) is approximately 76.5% iodine.
For purposes of radiation protection the Nuclear Regulatory Commission
(NRC) states in COMSECY-98-016 - FEDERAL REGISTER NOTICE ON POTASSIUM
IODIDE:
"In 1978, the U.S. Food and Drug Administration found
KI "safe and effective" for use in radiological emergencies
and approved its over-the-counter sale."
Most recently (November, 2001) the FDA states in Potassium
Iodide as a Thyroid Blocking Agent in Radiation Emergencies:
"FDA maintains that KI is a safe and effective means
by which to prevent radioiodine uptake by the thyroid gland,
under certain specified conditions of use, and thereby obviate
the risk of thyroid cancer in the event of a radiation emergency."
Q: How Does Potassium Iodide (KI) Pill
Provide Anti-Radiation Protection?
A: Going back to June 23, 1966, the New England Journal
of Medicine. Vol. 274 on Page 1442 states:
"The thyroid gland is especially vulnerable to atomic
injury since radioactive isotopes of iodine are a major component
of fallout."
Cresson H. Kearny, the author of Nuclear
War Survival Skills book, Original Edition Published September,
1979, by Oak Ridge National Laboratory, a Facility of the U.S.
Department of Energy (Updated and Expanded 1987 Edition) states
on page
111:
"There is no medicine that will effectively prevent
nuclear radiations from damaging the human body cells that they
strike.
However, a salt of the elements potassium and iodine, taken
orally even in very small quantities 1/2 hour to 1 day before
radioactive iodines are swallowed or inhaled, prevents about
99% of the damage to the thyroid gland that otherwise would
result. The thyroid gland readily absorbs both non-radioactive
and radioactive iodine, and normally it retains much of this
element in either or both forms.
When ordinary, non-radioactive iodine is made available
in the blood for absorption by the thyroid gland before any
radioactive iodine is made available, the gland will absorb
and retain so much that it becomes saturated with non-radioactive
iodine. When saturated, the thyroid can absorb only about l%
as much additional iodine, including radioactive forms that
later may become available in the blood: then it is said to
be blocked. (Excess iodine in the blood is rapidly eliminated
by the action of the kidneys.)"
The Nuclear Regulatory Commission (NRC) stated July 1, 1998 in
USE
OF POTASSIUM IODIDE IN EMERGENCY RESPONSE:
"Potassium iodide, if taken in time, blocks the thyroid
gland's uptake of radioactive iodine and thus could help prevent
thyroid cancers and other diseases that might otherwise be caused
by exposure to airborne radioactive iodine that could be dispersed
in a nuclear accident."
Federal Register. Vol. 43 Friday, December 15, 1978, states in
Potassium Iodide as a Thyroid Blocking Agent in a Radiation Emergency:
"Almost complete (greater than 90%) blocking of peak
radioactive iodine uptake by the thyroid gland can be obtained
by the oral administration of ... iodide ..."
National Council on Radiation Protection and Measurements. NCRP
Report NO. 55. Protection of the Thyroid Gland in the Event of
Releases of Radioiodine. August, 1979, Page 32:
"A major protective action to be considered after a
serious accident at a nuclear power facility involving the release
of radioiodine is the use of stable iodide as a thyroid blocking
agent to prevent thyroid uptake of radioiodines."
The recently updated (1999) World Health Organization (WHO) Guidelines
for Iodine Prophylaxis following Nuclear Accidents states:
"Stable iodine administered before, or promptly after,
intake of radioactive iodine can block or reduce the accumulation
of radioactive iodine in the thyroid."
And, finally, the recently (November, 2001) released FDA document
Potassium
Iodide as a Thyroid Blocking Agent in Radiation Emergencies states:
"The effectiveness of KI as a specific blocker of thyroid
radioiodine uptake is well established (Il'in LA, et al., 1972)
as are the doses necessary for blocking uptake. As such, it
is reasonable to conclude that KI will likewise be effective
in reducing the risk of thyroid cancer in individuals or populations
at risk for inhalation or ingestion of radioiodines."
Q: Is this the Magic Anti-Radiation Protection Pill?
A: Sorry, but there is no magic pill or medicine that will
protect you from all radiation sources. In fact, as already stated
above here:
"There is no medicine that will effectively prevent
nuclear radiations from damaging the human body cells that they
strike."
Also, the recently (November, 2001) released FDA document Potassium
Iodide as a Thyroid Blocking Agent in Radiation Emergencies states:
"KI provides protection only for the thyroid from radioiodines.
It has no impact on the uptake by the body of other radioactive
materials and provides no protection against external irradiation
of any kind. FDA emphasizes that the use of KI should be as
an adjunct to evacuation (itself not always feasible), sheltering,
and control of foodstuffs."
Potassium Iodide (and Potassium Iodate, KIO3) will provide a
very high level of thyroid protection, taken in time, for the
specific radio-isotopes of iodine, which is expected by many to
cause the majority of health concerns downwind from a nuclear
emergency. (And, is the reason most all developed countries have
stockpiled it.)
However, there are numerous other, and very dangerous, radioactive
noble gases and/or radioactive fallouts that can be associated
with nuclear emergencies. You are still exposed to inhale, ingest,
or be radiated externally from any number of dangerous non-radioiodine
sources.
If you are ever directed to evacuate in a nuclear emergency,
do so immediately, regardless of whether you have taken Potassium
Iodide (KI) or KIO3, or not.
Note: KI or KIO3 would likely not be needed for the so-called
"Dirty Bomb" or RDD (Radiological Dispersal Device).
Radioactive Iodine is only produced by a fission or fusion weapon
detonation or in a Nuclear Power Plant as a byproduct of that
process. An RDD simply spreads around existing radioactive material
and it's not very likely to have been composed of the relatively
short half-life radioactive iodine. We'd more likely see used
in an RDD a commercially abundant, and more easily obtained, isotope
like Cobalt-60, Cesium-137 or uranium fuel rods, etc.
Q: Radioactive Iodine: Bad News / Good
News!?!
A: The "bad news" first:
#1 - Radioactive iodine (predominantly
iodine-131) is a major radioisotope constituent in nuclear power
plants.
#2 - There are 103 currently
active commercial nuclear reactors and 39 operating nonpower reactors
in the United States. (434 worldwide as of 1998.) Additionlly,
there are numerous other nuclear processing and storage facilities
worldwide with the potential for accidents, too.
The, September 29, 1999, Tokaimura, Japan nuclear accident took
place, not in a nuclear reactor power plant, but in an uranium
processing plant. 
Radioactive iodine-131 gases were confirmed to have been released
and was the primary reason for 320,000 Japanese confined to their
homes with their windows shut. It was also why you may have seen
photos of Japanese authorities examining scores of children with
geiger counters pressed against their necks.
#3 - Radioactive iodine (predominantly
iodine-131) is also a major constituent of detonated nuclear weapons.
#4 - Radioactive iodine can not
only travel hundreds of miles on the winds, but also still remain
health threatening even as other radioisotopes are becoming dispersed
and diluted along with it and their likelyhood of causing harm
diminishes. It is often overlooked that while there will also
be many other dangerous radioisotopes released along with radioiodine,
if they are inhaled or ingested they are normally dispersed throughout
a body and pose less of a risk than if they were to be concentrated
into one small specific area of the body, like radioiodine is
in the thyroid gland. As a plume or cloud of radioactive isotopes
disperses with the wind its danger also diminshes, but always
much less quickly so for radioiodine because whatever little there
is that's inhaled will always be concentrated into that small
space of the thyroid gland.
NUREG-1633 points out an increase in thyroid cancer caused by
radioiodine from Chernobyl...
"...was detected in Belarus, Russia, and Ukraine. Notably,
this increase, seen in areas more than 150 miles (300 km) from
the site, continues to this day and primarily affects children
who were 0-14 years old at the time of the accident...the vast
majority of the thyroid cancers were diagnosed among those living
more than 50 km (31 miles) from the site."
The recently updated (1999) World Health Organization (WHO) Guidelines
for Iodine Prophylaxis following Nuclear Accidents states
in its abstract regarding thyroid cancer caused by the Chernobyl
disaster:
"This increase in incidence has been documented up to 500
km from the accident site."
...and therefore...
"...that stockpiling (KI or KIO3) is warranted, when feasible,
over much wider areas than normally encompassed by emergency planning
zones, and that the opportunity for voluntary purchase be part
of national plans."
Many are coming to see now that relying on the current U.S. policy
of public safety contingency plans focused on only protecting
the populations inside a small "Emergency Planning Zone"
(EPZ) of 5 to 10 miles around U.S. nuclear power plants is "overly
optimistic", to put it very mildly.
Undoubtably, US nuclear power plants are much better designed,
operated, and safer than many others elsewhere in the world, and
certainly many magnitudes safer than the Chernobyl operation ever
was. But, that doesn't mean much anymore when we aren't just concerned
with just accidents, but now sabotage or terrorist attacks, too.
Without anyone debating here how likely anything is to ever go
wrong, it must still be accepted by all that the logic of even
having any EPZ's established is to effectively provide for the
public safety in that rarest of events if/when anything did go
wrong. If that's why we've even bothered with having any EPZ's
at all, then shouldn't they be effective ones, if/when it's ever
really needed to protect the public downwind? Reality is, the
wind just won't know to stop blowing when it comes up against
the currently tiny 5-10-50 mile EPZ 'barriers'. (Find your upwind
nuclear power plants and daily updated plant status reports here.)
Also, read the fascinating Three
Mile Island: The Rest of the Story... (Why current EPZ's are much
too small.)
The wind, of course, doesn't respect state boundaries either
as our own Nevada atomic bomb testing program in the 1950s and
early 1960s made it possible that "...everyone living in
the contiguous 48 states was exposed to low levels of 131Iodine
(radioiodine) for several months following each nuclear bomb test."
(Radiation
Exposure and Thyroid Cancer - Memorial Sloan-Kettering Cancer
Center) Even more importantly; "The report also estimates
that children aged three to five years probably received doses
of radiation three to seven times higher than average during the
90 nuclear tests that were carried out."
Remember, it's always the children who are at the highest risk
of injury from radioactive iodine and eventually developing thyroid
cancer from that exposure. Each year, more than 12,000 Americans
find out they have thyroid cancer, though from various causes.
About 1000 here in the U.S. die from it yearly.
National Cancer Institute Study Estimating Thyroid Doses of
I-131
Received by Americans From Nevada Atmospheric Nuclear Bomb Tests
The NCI's 'worst case' estimate is that fallout
from nuclear weapons
testing likely generated from 10,000 to 75,000 cases of thyroid
cancer!
Executive Summary of that report here.
Additional details and fallout maps here.
Physicians for Social Responsibility: Critique
of NCI Report
And, of course, the wind also doesn't respect international boundaries
either, nor even continents and oceans, as fallout from a single
above ground Chinese nuclear test explosion ("a few hundred
kilotons") on December 28, 1966 resulted in the fallout cloud
covering most of the United States.
From Cresson H. Kearny's Nuclear
War Survival Skills:
"It produced fallout that by January 1, 1967 resulted in
the fallout cloud covering most of the United States. This one
Chinese explosion produced about 15 million curies of iodine-
131 - roughly the same amount as the total release of iodine-
131 into the atmosphere from the Chernobyl nuclear power plant
disaster."
"Fallout from the approximately 300 kiloton Chinese
test explosion shown in Fig. 1 caused milk from cows that fed
on pastures near Oak Ridge, Tennessee and elsewhere to be contaminated
with radioiodine, although not with enough to be hazardous to
health. However, this milk contamination (up to 900 picocuries
of radioactive iodine per liter) and the measured dose rates from
the gamma rays emitted from fallout particles deposited in different
parts of the United States indicate that trans-Pacific fallout
from even an overseas nuclear war in which "only" two
or three hundred megatons would be exploded could result
in tens of thousands of unprepared Americans suffering thyroid
injury." (Declassified Fallout Map and full story text in
Nuclear War Survival Skills at Trans-Pacific
Fallout)
Getting Back To The Future...
Commenting on the world health effects a nuclear exchange between
India and Pakistan would create, for example, Dr. Henry Kendall
of the Union of Concerned Scientists said in October of 1999:
"It would be very similar to Cherynobl. But it could be on
a substantially larger scale."
Accordingly, you also have to assess the probable threat from
nuclear war, either directed at the U.S. or fallout contamination
originating from elsewhere in the world. Russia, China, North
Korea, Pakistan, India, Middle East, etc., where any of them are
exchanging nuclear blasts with any of their neighbors, could have
the prevailing west-to-east trade winds carrying the resultant
radioactive fallout to our shores, too.
You'll have to decide whether that's an impossible scenario
in your families lifetime, or not. And, then prepare accordingly.
#5 - Radioactive iodine (radioiodine)
persists in the environment for a month or more.
#6 - Most importantly, ingested
or inhaled radioactive iodine (radioiodine) persists in the body
and concentrates in the thyroid. (Excess iodine in the blood,
either radioiodine or stable iodine, is quickly eliminated from
the body, but only after the thyroid has become saturated with
one or the other type of iodine.) Even very small amounts of radioactive
iodine, because it is retained in the small space of the thyroid,
eventually will give such a large radiation dose to thyroid cells
there that abnormalities are likely to result. These would include
loss of thyroid function, nodules in the thyroid, or thyroid cancer.
The most likely to see the worst effects, in later life, are the
youngest children. (Many of the Chernobyl thyroid cancers appearing
in the former Soviet Union among young people today were just
children less than five years old at the time of the accident.
Experts now contend that as high as 40% of the nodules are cancerous
with 5 to 10 percent of the cancers fatal.)
Every year researchers are discovering more from Chernobyl as
its legacy continues to reveal itself. According to the World
Health Organization, that disaster will cause 50,000 new cases
of thyroid cancer among young people living in the areas most
affected by the nuclear disaster. Researchers have also found
that in certain parts of Belarus, for example, 36.4 per cent of
children, who were under the age of four at the time of the accident,
can expect to develop thyroid cancer.
For all of the above reasons, health experts estimate that
the greatest health concerns affecting the largest number of people
from a nuclear accident, or nuclear bomb explosion(s) anywhere
in the world, will likely be from the release of radioactive iodine
then carried downwind.
However, there really is some Good News amongst all this!
This deadly cancer agent, especially to our children, is easily,
cheaply, and effectively blocked!
As mentioned above;
"...a salt of the elements potassium and iodine, taken
orally even in very small quantities 1/2 hour to 1 day before
radioactive iodines are swallowed or inhaled, prevents about 99%
of the damage to the thyroid gland that otherwise would result."
The Nuclear Regulatory Commission (NRC) states in COMSECY-98-016
- FEDERAL REGISTER NOTICE ON POTASSIUM IODIDE:
The Chernobyl accident demonstrated that thyroid cancer
can indeed be a major result of a large reactor accident. Moreover,
although the Food and Drug Administration declared KI "safe
and effective" as long ago as 1978, the drug had never
been deployed on a large scale until Chernobyl. The experience
of Polish health authorities during the accident has provided
confirmation that large scale deployment of KI is safe.
Additionally, it goes on to say:
The revised policy also reflects wide scale change in international
practice following the Chernobyl disaster, specifically 1989
World Health Organization recommendations (updated in 1995)
and 1996 and 1997 International Atomic Energy Agency standards
and guidance, which have led to use of KI as a supplementary
protective measure in much of Europe, as well as in Canada and
Japan.
Also, the newly released (November, 2001) FDA document entitled:
Potassium
Iodide as a Thyroid Blocking Agent in Radiation Emergencies
states:
"Thus, the studies following the Chernobyl accident
support the etiologic role of relatively small doses of radioiodine
in the dramatic increase in thyroid cancer among exposed children.
Furthermore, it appears that the increased risk occurs with
a relatively short latency. Finally, the Polish experience supports
the use of KI as a safe and effective means by which to protect
against thyroid cancer caused by internal thyroid irradiation
from inhalation of contaminated air or ingestion of contaminated
food and drink when exposure cannot be prevented by evacuation,
sheltering, or food and milk control."
What they learned was that children, with their thyroid glands
being the most sensitive to radioactive iodine uptake, have today
grown up to be the most frequent victims of thyroid cancers there.
The children in Russia, the Ukraine and Belarus, where potassium
iodide (KI) was not widely distributed, are now experiencing high
levels of thyroid cancer. However, in Poland, where over 18 million
doses of Potassium Iodide (KI) were administered, and to 97 percent
of the children, there has been no similar increase in thyroid
cancer. Also, key to Poland's radioiodine protective strategy,
was their aggressive interdiction of radioiodine contaminated
food stuffs and milk.
Bottom Line: For all its serious potential for widespread
damage to populations (and especially among our youngest), far
downwind from the site of a nuclear event, radioiodine health
concerns can be largely neutralized by inexpensive thyroid blocking
via prompt prophylactic use of potassium iodide (KI). This, in
addition to successful evacuation, when indicated, and vigilance
that food and milk are not also radioiodine contaminated, has
proven itself the best combination strategy.
Q: Dosage and Safety Regarding Potassium
Iodide (KI) Usage?
A: In April of 1982 the Bureau of Radiological Health and
Bureau of Drugs, Food and Drug Administration, Department of Health
and Human Services released "FINAL RECOMMENDATIONS, Potassium
Iodide As A Thyroid-Blocking Agent In A Radiation Emergency: Recommendations
On Use". These lengthy recommendations are summarized in
the FDA's "mandated patient product insert". (See a
complete copy below.) This insert is packed with every bottle
of non-prescription Potassium Iodide (KI) tablets sold. However,
the lengthy FDA recommendations contain many facts not mentioned
in this required insert, including the following:
"Based on the FDA adverse reaction reports and an estimated
48 x 106 [48 million] 300-mg doses of potassium iodide administered
each year [in the United States], the NCRP [National Council
on Radiation Protection and Measurements] estimated an adverse
reaction rate of from 1 in a million to 1 in 10 million doses."
(It should be pointed out that this extremely low adverse reaction
rate is for doses over twice as large as the 130-mg prophylactic
dose.)
NOTE: The following 'old' FDA Recommendations were recently
revised. See details and link to the new (November, 2001) FDA
guidelines immediately below this grey box.
FDA PATIENT INFORMATION USE OF 130-MG
SCORED TABLETS OF POTASSIUM IODIDE FOR THYROID BLOCKING
(Potassium Iodide Tablets, U.S.P.)
(Pronounced poe-TASS-e-um EYE-oh-dyed)
(Abbreviated KI)
TAKE POTASSIUM IODIDE ONLY WHEN PUBLIC
HEALTH OFFICIALS TELL YOU. IN A RADIATION EMERGENCY, RADIOACTIVE
IODINE COULD BE RELEASED INTO THE AIR. POTASSIUM IODIDE (A FORM
OF IODINE) CAN HELP PROTECT YOU.
IF YOU ARE TOLD TO TAKE THIS MEDICINE,
TAKE IT ONE TIME EVERY 24 HOURS. DO NOT TAKE IT MORE OFTEN. MORE
WILL NOT HELP YOU AND MAY INCREASE THE RISK OF SIDE EFFECTS. DO
NOT TAKE THIS DRUG IF YOU KNOW YOU ARE ALLERGIC TO IODINE (SEE
SIDE EFFECTS BELOW).
INDICATIONS
THYROID BLOCKING IN A RADIATION EMERGENCY
ONLY
DIRECTIONS
FOR USE
Use only as directed by State or local
public health authorities in the event of a radiation emergency.
DOSE
ADULTS AND CHILDREN ONE YEAR OF AGE
OR
OLDER: One (1) tablet once a day. Crush
for small children.
BABIES UNDER ONE YEAR OF AGE: One-half
(1/2) tablet once a day. Crush first.
DOSAGE: Take for 10 days unless directed
otherwise by State or local public health authorities.
Store at controlled room temperature
between 15 and 30C (59 degrees to 86 degrees F). Keep bottle tightly
closed and protect from light.
WARNING
POTASSIUM IODIDE SHOULD NOT BE USED
BY PEOPLE ALLERGIC TO IODIDE. Keep out of the reach of children.
In case of overdose or allergic reaction, contact a physician
or public health authority.
DESCRIPTION
Each (company trade name) Tablet contains
130 mg. of potassium iodide.
HOW
POTASSIUM IODIDE WORKS
Certain forms of iodine help your thyroid
gland work right. Most people get the iodine they need from foods
like iodized salt or fish. The thyroid can "store" or
hold only a certain amount of iodine.
In a radiation emergency, radioactive
iodine may be released in the air. This material may be breathed
or swallowed. It may enter the thyroid gland and damage it. The
damage would probably not show itself for years. Children are
most likely to have thyroid damage.
If you take potassium iodide, it will
fill up your thyroid gland. This reduces the chance that harmful
radioactive iodine will enter the thyroid gland.
WHO
SHOULD NOT TAKE POTASSIUM IODIDE
The only people who should not take
potassium iodide are people who know they are allergic to iodide.
You may take potassium iodide even if you are taking medicines
for a thyroid problem (for example, a thyroid hormone or anti-thyroid
drug). Pregnant and nursing women and babies and children may
also take this drug.
HOW
AND WHEN TO TAKE POTASSIUM IODIDE
Potassium iodide should be taken as
soon as possible after public health officials tell you. You should
take one dose every 24 hours. More will not help you because the
thyroid can "hold" only limited amounts of iodine. Larger
doses will increase the risk of side effects. You will probably
be told not to take the drug for more than 10 days.
SIDE
EFFECTS
Usually, side effects of potassium iodide
happen when people take higher doses for a long time. You should
be careful not to take more than the recommended dose or take
it for longer than you are told. Side effects are unlikely because
of the low dose and the short time you will be taking the drug.
Possible side effects include skin rashes,
swelling of the salivary glands, and "iodism" (metallic
taste, burning mouth and throat, sore teeth and gums, symptoms
of a head cold, and sometimes stomach upset and diarrhea).
A few people have an allergic reaction
with more serious symptoms. These could be fever and joint pains,
or swelling of parts of the face and body and at times severe
shortness of breath requiring immediate medical attention.
Taking iodide may rarely cause overactivity
of the thyroid gland, underactivity of the thyroid gland, or enlargement
of the thyroid gland (goiter).
WHAT
TO DO IF SIDE EFFECTS OCCUR
If the side effects are severe or if
you have an allergic reaction, stop taking potassium iodide. Then,
if possible, call a doctor or public health authority for instructions.
HOW
SUPPLIED
Tablets (Potassium Iodide Tablets, U.S.P.):
bottles of [number of tablets in a bottle] tablets
( ). Each white, round, scored tablet
contains 130 mg. potassium iodide.
The FDA new (November, 2001) guidance document, that brings
it more in-line with the recent World Health Organization recommendations
below, is titled; "Potassium Iodide as a Thyroid Blocking
Agent in Radiation Emergencies".
It can be seen here.
This represents the Food and Drug Administration's current thinking
on this topic.
In regards to the differences between the World Health Organization
dosing recommendations and these new FDA recommendations, this
FDA document states:
These FDA recommendations differ from those put forward in
the World Health Organization (WHO) 1999 guidelines for iodine
prophylaxis in two ways. WHO recommends a 130-mg dose of KI
for adults and adolescents (over 12 years). For the sake of
logistical simplicity in the dispensing and administration of
KI to children, FDA recommends a 65-mg dose as standard for
all school-age children while allowing for the adult dose (130
mg, 2 X 65 mg tablets) in adolescents approaching adult size.
The other difference lies in the threshold for predicted exposure
of those up to 18 years of age and of pregnant or lactating
women that should trigger KI prophylaxis. WHO recommends a threshold
of 1 cGy for these two groups. As stated earlier, FDA has concluded
from the Chernobyl data that the most reliable evidence supports
a significant increase in the risk of childhood thyroid cancer
at exposures of 5 cGy or greater.
|
Threshold Thyroid Radioactive Exposures
and
Recommended Doses of KI for Different Risk Groups
|
|
|
Predicted Thyroid exposure(cGy)
|
KI dose (mg)
|
# of 130 mg
tablets
|
# of 65 mg
tablets
|
|
Adults over 40 yrs
|
Greater Than or Equal to 500
|
130
|
1
|
2
|
|
Adults over 18 through 40 yrs
|
Greater Than or Equal to 10
|
|
Pregnant or lactating women
|
Greater Than or Equal to 5
|
|
Adoles. over 12 through 18 yrs*
|
65
|
1/2
|
1
|
|
Children over 3 through 12 yrs
|
|
Over 1 month through 3 years
|
32
|
1/4
|
1/2
|
|
Birth through 1 month
|
16
|
1/8
|
1/4
|
|
*Adolescents
approaching adult size (> 70 kg)
should receive the full adult dose (130 mg)
|
The World Health Organization recent recommendations has a step
increase in doses by age (chart below) and also states the potential
benefit diminishes with older adults. In fact, if only a limited
number of Potassium Iodide (KI) or KIO3 tablets are available,
these should always be given to infants, children and young adults
first as they are the most vulnerable and also the risk of thyroid
cancer fully developing begins to drop off with adults much over
40 years of age.
The World Health Organization (WHO) Guidelines
for Iodine Prophylaxis following Nuclear Accidents states:
"In general, the potential benefit of iodine prophylaxis
will be greater in the young, firstly because the small size
of the thyroid means that a higher radiation dose is accumulated
per unit intake of radioactive iodine. Secondly, the thyroid
of the fetus, neonate and young infant has a higher yearly thyroid
cancer risk per unit dose than the thyroid of an adult and,
thirdly, the young will have a longer time span for the expression
of the increased cancer risk."
Also, the newly released (November, 2001) FDA document entitled
Potassium
Iodide as a Thyroid Blocking Agent in Radiation Emergencies
determined from the Chernobyl data that:
"They suggest that the risk of thyroid cancer is inversely
related to age, and that, especially in young children, it may
accrue at very low levels of radioiodine exposure." and
also that "...adults over 40 need take KI only in the case
of a projected large internal radiation dose to the thyroid
(>500 cGy) to prevent hypothyroidism."
Dosing chart from the recently updated 1999 World Health Organization:
Guidelines
for Iodine Prophylaxis following Nuclear Accidents
|
Age Group
|
Mass of Iodine mg
|
Mass of KI mg
|
Mass of KIO3 mg
|
Fraction of 100 mg Iodine
|
|
Adults and Adolescents
(over 12 yrs)
|
100
|
130
|
170
|
1
|
|
Children
(3-12 years)
|
50
|
65
|
85
|
1/2
|
|
Infants
(1 months to 3 years)
|
25
|
32
|
42
|
1/4
|
|
Neonates
(birth to 1 month)
|
12.5
|
16
|
21
|
1/8
|
To help make sense of any possible dosing confusion and radiation
level thresholds, it should be remembered first that you should
not commence dosing until so directed by a doctor or public health
officials. Also, the biggest difference in dosage and ages, between
the two recommendations, is that WHO suggests an adult dose (130mg
KI) for everyone over 12 where the FDA suggests an adult dose
for everyone over 18, unless the adolescent weighs 70kg (154 lbs)
or more. And, again, the primary reason for this divergence from
the WHO recommendations is that, according to the FDA: For the
sake of logistical simplicity in the dispensing and administration
of KI to children, FDA recommends a 65-mg dose as standard for
all school-age children while allowing for the adult dose (130
mg, 2 X 65 mg tablets) in adolescents approaching adult size.
At the WHO dosages recommended above, an adverse reaction rate
of less than 1 in 10 million children and less than 1 in 1 million
adults is expected. However, Potassium Iodide should not be used
by people allergic to iodine. According to the WHO, contraindications
for use of potassium iodide are: (1) past or present thyroid disease
(e.g., active hyperthyroidism), (2) known iodine hypersensitivity,
(3) dermatitis herpetiformis, and (4) hypocomplementaemic vasculitis.
You should also check with your doctor before taking this medication
if you have myotonia or hyperkalemia congenita or tuberculosis
or kidney disease. See http://www.mayoclinic.com
for more information.
Pregnant women should consult a physician prior to continuing
dosages for more than two days. According to the WHO, "No
negative consequences are to be expected after one or two doses
of stable iodine. However, especially in areas with dietary iodine
deficiency, prolonged dosage could lead to maternal and/ or fetal
thyroid blockage, with possible consequences for fetal development.
... Pregnant women with active hyperthyroidism must not take stable
iodine because of the risk of fetal thyroid blockage."
For pregant or nursing women, and for cautions to the proper
dosing of neonates, also read the appropriate sections here in
the newly released (November, 2001) FDA document entitled Potassium
Iodide as a Thyroid Blocking Agent in Radiation Emergencies.
The WHO also states, and the FDA concurs, "Side effects
in other parts of the body, such as gastrointestinal effects or
hypersensitivity reactions, may occur but are generally mild and
can be considered of minor importance."
One additional recommendation we urge at KI4U, now before
any nuclear emergencies, is simply to check with your doctor and
inquire whether there is any possibility of any adverse reactions
if you, or your children, had to begin taking KI or KIO3. If you
are concerned enough to be reading this and considering acquiring
KI or KIO3 for your family, then checking with your doctor first
should be a natural step in your prudent preparations, too.
Besides contraindications with pre-exisiting medical conditions,
this is also important if you (or they) are taking any regular
medications. Especially, though not limited to, Spironolactone
(like Aldactone), Triamterene (Dyrenium), Amiloride (Midamor),
or medicines for an overactive thyroid, or if you are on medications
with any lithium-based or potassium-sparing diuretics.
Better to have gotten that assurance from your physician now,
before any emergencies, rather than risk hesitating taking it
later (or possibly suffering an adverse reaction) because you
didn't ask first. Again, that's just a part of your prudent preparations,
where anyone else being issued Potassium Iodide (KI) during an
emergency probably won't have that opportunity to find out first!
We have a fair number of medical doctors (often initially
sent by their patients), pharmacists, health physicists, and medical
schools refer to this FAQ. We are very grateful for the medical
communities generous suggestions, and additional related research
we've received or have been pointed to. We invite any/all input
from the medical community to better fine-tune or expand the research
documented at the Potassium Iodide Anti-Radiation Pill FAQ.
Q: Is Iodized Salt, Tincture of Iodine,
Water Purification Tabs, or other Iodine Sources Effective?
A: Any dietary iodine sources providing for a normal daily
sufficient regimen of iodine intake (about 150 micrograms/day
in adults) is preferred in that it will then take less stable
iodine (and time) to saturate your thyroid in a nuclear emergency
and there will be less room there for radioactive iodine before
you do. An iodine sufficient diet will also greatly increase the
effectiveness of KI or KIO3, but primarily only in the following
limited context and not as a substitute for KI or KIO3:
An iodine sufficient diet is most beneficial, compared to an
insufficient iodine diet, when the initial administration of
KI had been unavoidably delayed and the KI could only be first
taken after exposure to radioiodine.
From the Health Physics Journal, Volume 78 No. 6, June 2000,
"EFFECTS OF TIME OF ADMINISTRATION AND DIETARY IODINE LEVELS
ON POTASSIUM IODIDE (KI) BLOCKADE OF THYROID IRRADIATION BY 131-I
FROM RADIOACTIVE FALLOUT" Pat B. Zanzonico and David V. Becker
(Read abstract by searching title at Health Physics Journal):
"The 131-I thyroid absorbed dose is two-fold greater
with insufficient levels of dietary iodine, 2,900 cGy/37 MBq,
than with sufficient levels of dietary iodine, 1,500 cGy/37
MBq. When KI is administered 48 h or less before 131-I intake,
the thyroid absorbed doses (in cGy/37 MBq) are comparably low
with both sufficient and insufficient dietary iodine levels.
When KI is administered after 131-I intake, however, the protective
effect of KI is less and decreases more rapidly with insufficient
than with sufficient dietary iodine. For example, KI administration
2 and 8 h after 131-I intake yields protective effects of 80
and 40%, respectively, with iodine-sufficient diets, but only
65 and 15% with iodine-deficient diets."
However, in regards to the effective thyroid-blocking protection
directly afforded by various sources of dietary iodine, and other
iodine applications, taken alone without also utilizing KI or
KIO3, it was found...
From the Salt
Institue:
"U.S. salt producers use potassium iodide at a level
of 0.006% to 0.01% KI."
According to Morton® Salt:
"Each 1/4 teaspoon serving of Morton® Iodized Salt
(1.5 gram weight) contains 130 MICROGRAMS of Potassium
Iodide."
Thus, to achieve an intake of 130 MILLIGRAMS of Potassium
Iodide (what one KI adult dose tablet contains) would require
ingesting 250 teaspoons or over 5 cups of iodized salt per day!
Don't even think about it! (Morton Lite Salt® Mixture comes
in lower yet, at only 90 MICROGRAMS of Potassium Iodide
per 1/4 teaspoon!)
Sea Salt is an even worse 'option'. Iodine per Kilogram
of sea salt is about 3 mg. You'd be looking at over 33 kilograms
of Sea Salt a day! Hardly an option!
A 6-ounce portion of ocean fish only contains about 500
MICROGRAMS of iodine. Some specific seafoods, portion size
and their iodine content in MICROGRAMS: Mackerel 150g 255 mcg,
Mussels 150g 180 mcg, Cod 150g 165 mcg, Kipper 150g 107 mcg, Whiting
150g 100 mcg, Fish fingers 75g 75 mcg, Scampi 150g 62 mcg, Herring
150g 48 mcg, Prawns 150g 42 mcg, Sardines, canned in oil 150g
35 mcg, Trout 150g 24 mcg, Tuna 150g 21 mcg.
Well, you can do the math here! More fish per day than most eat
in a year!
Kelp Tablets...hardly. Solgar® Kelp Tablets, for example,
contain only 225 MICROGRAMS of iodine! (Fortunately, it
is also available in a 1000 tablet bottle, unfortunately though,
you'd need to be swallowing 442 of them per day and not wander
too far from a bathroom!)
Medicines containing Potassium Iodide: Potassium iodide
(KI) is an old drug used as an expectorant in the treatment of
asthma, bronchitis and emphysema. It is used to treat coughs with
phlegm, feeling of fullness in the chest or pressure in the face/sinuses.
Potassium iodide helps loosen phlegm (mucus) and thin bronchial
secretions to drain bronchial tubes and make coughs more productive.
It increases secretions in the respiratory tract in approximately
30 min. Today it is mainly used to treat an overactive thyroid
and, of course, to protect the thyroid gland from the effects
of radiation from inhaled or swallowed radioactive iodine. Potassium
iodide also has anti-infective properties and is sometimes used
to treat certain skin conditions caused by fungus, like toenail
fungus.
PIMA (Fleming & Company) and SSKI (Upsher-Smith Laboratories,
Inc.) are both available in tablets or liquid, but only with a
prescription. Another, that used to be a non-prescription cough
and expectorant medicine available over-the-counter (OTC) is Pediacof
Cough made by Sterling Health, a Division of Miles, Inc. Common
5 ml dose contains Chlorpheniramine 0.75 mg, Codeine 5 mg, Phenylephrine
2.5 mg, Potassium Iodide 75 mg.
Any of the above may or may not be available from your local
pharmacy with a prescription from your doctor. We can't and don't
recommend you ever take any drug for any reason other than what
it was intended for, nor that the suggested dosages should ever
be exceeded. There may be other OTC medicines containing Potassium
Iodide on the market as well, please pass them on here if you
discover any.
Also, FYI, Potassium Iodide can be found in some livestock preparations,
too, such as Equi-Tussin, which is a liquid expectorant and aromatic
oil supplement for horses. It contains 125 mg of Potassium Iodide
per fluid ounce, but it also contains Molasses, Mentholated Syrup
of White Pine, Eucalyptus Oil, Peppermint Oil, Glyceryl Guiacolate
and Ammonium Chloride and is obviously formulated for horses,
not people. You might want to keep this in mind, though, for protecting
your livestock and pets.
Regarding ingesting (drinking/swallowing) iodine, iodine tablets
(widely sold for water purification), tincture of iodine,
or Povidone-iodine solutions (like the Betadine® brand solution):
Cresson H. Kearny, the author of Nuclear
War Survival Skills, Original Edition Published September,
1979, by Oak Ridge National Laboratory, a Facility of the U.S.
Department of Energy (Updated and Expanded 1987 Edition) states
on page
115:
Elemental (free) iodine is poisonous, except in the very
small amounts in water disinfected with iodine tablets or a
few drops of tincture of iodine. Furthermore, elemental iodine
supplied by iodine tablets and released by tincture of iodine
dropped into water is not effective as a blocking agent to prevent
thyroid damage. If you do not have any potassium iodide, DO
NOT TAKE IODINE TABLETS OR TINCTURE OF IODINE.
Iodine is normally used in doses of 8 PPM to treat clear water
for a 10 minute contact time. The effectiveness and safety of
this dose has been shown in numerous studies. As far back as 1953
in the study "Test of chronic toxicity of iodine as related
to the purification of water". U.S. Armed Forces medical
journal, 1953, 4:725-728 Morgan DP, Karpen RJ., it was shown that:
"No adverse health effects were reported in men who
drank water providing iodide at doses of 0.17-0.27 mg/kg of
body weight per day for 26 weeks"
That works out to a reported safe ingestion of elemental iodine
via treated water of between 14 and 22 mg per day for an 180 lb
adult. To attempt to achieve a thyroid-blocking dose of nearly
100 mg of iodine (the iodine content of a 130 mg KI tablet) would
thus require exceeding that proven safe level by a factor of at
least four to seven times for an 180 lb adult. And, this would
be with potentially poisonous elemental free iodine that is also
claimed above by Cresson H. Kearny to be "...not effective
as a blocking agent to prevent thyroid damage."
Additionally, USP tincture of iodine contains 2% iodine and 2.4%
sodium iodide dissolved in 50% ethyl alcohol and according to
the National Academy of Sciences in Drinking Water and Health.
Vol. 3. Washington, DC, National Academy Press, 1980.
Doses of 30-250 ml of tincture
of iodine (about 16-130 mg of total iodine per kg of body weight)
have been reported to be fatal.
The small typical one ounce bottle of tincture of iodine contains
about two tablespoons or approximately 30 ml of fluid. (The larger
pint bottles contain 473 ml.) To a small child, ingesting the
small 1 ounce bottle, even if well diluted to make it palatable,
could prove fatal.
Everyone needs to understand that all 'tincture of iodine'
bottles are clearly marked "POISON" for a very good
reason. Ingesting elemental free iodine, such as 'tincture of
iodine', in quantities sufficient to attempt thyroid-blocking
in a nuclear emergency is not a safe, nor an effective, alternative.
Finally, if someone does attempt thyroid-blocking for themselves
or their children by ingesting iodine, iodine water purification
tablets, tincture of iodine, or Povidone-iodine solutions
(like the Betadine® brand solution), and
we are strongly advising against it, they can look
forward to:
- shock (potentially fatal lowering of blood pressure)
- extreme thirst
- metallic taste
- sore teeth, gums and mouth
- severe headache
- fever
- no urine output (kidney failure)
- corrosive effects on the gastrointestinal tract
- esophageal stricture, asphyxiation (swelling of the throat,
esophagus)
- vomiting
- diarrhea
- abdominal pain with internal damage
- delirium
- stupor
Then, be prepared to call the Poison Control center for further
guidance.
DO NOT INDUCE VOMITING. Give milk, cornstarch, or flour by mouth
(15 gm in 500 ml, or just over a pint of water). Continue to give
milk every 15 minutes.
And, at the Emergency Room expect some or all of the following
procedures to be performed: Gastric lavage (depending on the extent
of esophageal injury), establish and maintain airway, be given
milk every 15 minutes, and treatment for the symptoms.
Topical Iodine Applications
There has been some interesting research, though, with both humans
and dogs into topically (on the skin) applied Povidone-Iodine
(10%) solution (such as Betadine® or Povidex® solutions),
and also with tincture of iodine, to test the absorption rates
of iodine directly through the skin. But, it was found not to
be as quick in providing thyroid blocking as oral Potassium Iodide
(KI) or KIO3, nor as consistent, and then, often, at lower levels
of protection. Questions remain of skin irritation, determining
the amount of Iodine solution to apply, where best to apply it,
how long to apply it, and the effects of temperature and humidity
on absorption through the skin. Also, insufficient testing has
been done on specific groups, such as infants, children, and pregnant
and nursing women to know how effective it would be and the full
range of complications that could be expected with repeated applications.
For instance, the skin absorption of iodine products in neonates
with inhibition of thyroid function has been documented in the
past. The use of Povidone-Iodine is the most frequent cause of
this type of intoxication. Another study showed that Povidone-Iodine
did not significantly influence neonatal thyroid function if they
were used to a full term neonate only once and even to a wide
skin surface.
Another source, non-medical, claims that by using the stronger
7% tincture iodine and just dipping the index finger of the person
being treated up to the first knuckle (just above the fingernail)
would provide the proper dosing. They claim this would work for
all people as our fingers are roughly proportionate to our size
and weight. That may be true, but that this technique would actually
provide sufficient quantity and effective absorption of iodine
for thyroid-blocking has not been verified. (Additional documentation
and source references have been requested of that author. And,
will be promptly posted here if provided.)
Clearly more research is needed before embracing the topically
applied techniques as a one-size-fits-all solution, as its limitations
must first be more fully understood. However...
According to research by Health Physicist Ken Miller, Hershey
Medical Center, using 24 healthy adult male subjects, an adult
could get a blocking dose of stable iodine by painting 8 ml of
a 2 percent tincture of Iodine on the abdomen or forearm approximately
2 hours prior to I-131 contamination. The abstract of his study
titled "Effectiveness of Skin Absorption of Tincture of I
in Blocking Radioiodine from the Human Thyroid Gland" from
Health Physics, June 1989, Vol. 56, No. 6, pages 911-914, (To
read abstract, search the title of the article here)
states:
"Although there were large variations within each subject
group in regard to serum-I levels and thyroid uptakes, the increase
in serum-I concentration after topical-I application was effective
in reducing the thyroid uptake of I131. The authors conclude
that in the absence of KI, most humans would benefit from topical
application of tincture of-I, and that in some the effectiveness
would equal that of oral KI."
Hmmm... interesting Plan "B"(Betadine®) possibilities
here, if in a pinch!
This author continues to see e-mails and forum postings highlighting
some of the ongoing confusion regarding different iodine sources
and their abilities to provide sufficient levels of iodine for
thyroid-blocking radioiodine.
This should help clear it up some more...
Potassium iodide (KI) is 76.5% iodine.
If the FDA recommended amount required for thyroid-blocking radiation
protection is 130 milligrams of KI, then that translates into
99.45 milligrams of elemental iodine.
If you are looking at a product, like a kelp liquid for example,
that says on the label...
"2 drops contain -kelp standardized with potassium
iodide to contain 0.15 mg (150mcg) of pure organic iodine (150%RDA)"
Then, to attain 99.45 milligrams of iodine (same as what's in
one 130 mg tablet of KI) would require ingesting 663 double drops
or X 2 = 1326 single drops.
A couple drops is just fine for dietary supplementation of required
iodine, but woefully underpowered for saturating the thyroid for
radioiodine radiation protection.
Q: Is the Government Ready with Emergency
Stocks of Potassium Iodide (KI)?
A: No, but they clearly ought to be according to KI
And Nuclear Accidents - AMERICAN THYROID ASSOCIATION:
"The American Thyroid Association through its Public
Health Committee has strongly recommended the stockpiling of
KI for prophylaxis in the event of a nuclear reactor accident.
Unfortunately, the Nuclear Regulatory Commission has not accepted
this recommendation."
Even the latest (November, 2001) FDA document entitled Potassium
Iodide as a Thyroid
Blocking Agent in Radiation Emergencies states:
"As time is of the essence in optimal prophylaxis with
KI, timely administration to the public is a critical consideration
in planning the emergency response to a radiation accident and
requires a ready supply of KI." and "FDA also emphasizes
that emergency response plans and any systems for ensuring availability
of KI to the public should recognize the critical importance
of KI administration in advance of exposure to radioiodine."
But, at least your government is talking about it again...
U.S. Lacks Stockpile of Special Drug
Anti-Radiation Doses Goal Unmet Since '79
By Justin Gillis
Washington Post Staff Writer
Monday, December 31, 2001; Page A01
A generation ago, as a nuclear disaster
unfolded in central Pennsylvania and 140,000 people fled the area,
pharmaceutical executives were rousted from bed in the middle
of the night by a plea for help.
At the federal government's request, they
cranked up a production line in Illinois at 3 a.m., and hours
later, thousands of bottles of potassium iodide, an anti-radiation
drug, were secretly rushed to Harrisburg by military jet. Ultimately
the nuclear reactor at Three Mile Island was brought under control
and the drug was not needed, but it was a close call. When it
was over, policymakers in Washington vowed to stockpile the drug,
saying they would not be caught short again.
It never happened.
Terrorists have spoken longingly of their
desire to blow up the United States' nuclear plants and poison
the land with radiation. But if a nuclear disaster were to occur
today, whether by terrorist strike or otherwise, the government
might well be in the same position it was in1979, trying to scare
up supplies of the drug on short notice.
Potassium iodide is often billed on the
Internet as a panacea for a nuclear emergency. It is nothing of
the sort, offering no protection for most types of radiation exposure.
But there is strong scientific evidence that it can protect the
thyroid gland, the most radiation-sensitive part of the body,
from absorbing trace amounts of radioactive iodine, particularly
in young children.
Despite that finding, there has long been
a serious debate about how valuable stockpiles of the drug would
be in a real-world emergency, since it is most effective when
taken within a couple of hours of radiation exposure. Unless people
already had it in their houses, skeptics argue, getting it to
them that quickly would be difficult, at best. Most European countries
and four U.S. states stockpile the drug for general public use,
while the rest of the states and the federal government do not.
That policy is under renewed scrutiny since
the Sept. 11 attacks and the anthrax scare that followed. The
federal government was better prepared for the anthrax emergency,
in fact, than it would be to distribute potassium iodide for radiation.
It had stockpiled millions of doses of antibiotics and was able
to draw on those stores when thousands of exposed people needed
preventive medicine. The lack of a potassium iodide stockpile
irks many doctors and other experts who have delved into the issue.
"The first thing is, there ain't none
available," said David Becker, a Cornell University specialist
in thyroid diseases. "Some of us in organizations like the
American Thyroid Association have been yelling and screaming for
15 years about this. It seems to me it doesn't make any sense
for the U.S. not to have any at all."
Potassium iodide is not expensive, nor
is it difficult to manufacture or store for long periods. The
drug is approved for thyroid protection by the Food and Drug Administration,
a position the agency reiterated earlier this month.
One reason for the lack of a stockpile
is that, however cheap it may be, potassium iodide is also controversial.
The nuclear power industry, which stocks
potassium iodide to protect workers in its plants, has long opposed
a large public stockpile, carrying as it would the implication
that nuclear power might be unsafe.
Some experts charged with protecting the
public from radiation oppose it, too, fearing the drug would be
seen as a cure-all. These experts contend that evacuation and
careful monitoring of the food supply would be better ways to
protect public health.
In the halls of Congress and elsewhere
in the nation, these arguments are being scrutinized anew. The
Nuclear Regulatory Commission, after going back and forth for
years, has adopted a policy that is mildly favorable toward potassium
iodide. The Health and Human Services Department is considering
whether to add the drug to its national anti-terrorism stockpile.
Under the new NRC policy, states must decide
whether to tap NRC funds to create regional or local stockpiles.
This means a public discussion of the drug and its potential usefulness
is likely to occur in virtually every state over the next year.
The drug is a hot political issue in some
communities. Alabama, Arizona, Maine and Tennessee already have
some form of stockpiling. The citizens of Duxbury, Mass., who
live near a nuclear plant, passed a stockpiling plan last year.
Vermont recently pledged an expanded stockpile, and a vigorous
debate is underway throughout New England and in some towns in
New York.
The World Health Organization recommends
stockpiling for every country with nuclear reactors operating
within or near its borders. Ireland just announced plans to send
the drug to every household in the country.
Potassium iodide availability is one of
those issues that rarely rises to public awareness, but it has
a long underground history that has played out in Washington and
in state capitals over decades. The arguments being heard today
are familiar ones to participants in that debate, with fear of
terrorism as the new twist.
"In the immortal words of Yogi Berra,
it's déjà vuall over again," said Jerome Halperin,
the man who rousted pharmaceutical executives from bed during
the Three Mile Island crisis. He was then an officer of the FDA,
and he has a hard time believing the nation has no stockpile 22
years after the federal government promised to build one.
"It's the appropriate, rational, public-health-preparedness
thing to do," he said. "Why wouldn't we expect it?"
But others are skeptical of the value of
stockpiling. Illinois, for instance, has 11 nuclear reactors operating
on six sites, more than any other state, and it has made some
of the most elaborate plans in the nation for responding to a
radiation emergency. They call for people to evacuate or take
shelter when necessary to escape a radiation plume, but they do
not call for potassium iodide. Most other states that have considered
the issue have adopted the same position.
The Nuclear Energy Institute, a trade association
for the nuclear industry that has long opposed stockpiling, says
it can live with the new NRC policy, but its experts remain skeptical
of the real-world value of potassium iodide. "Concern No.
1 is that people not get confused that this is some sort of panacea
for any kind of radiation exposure," said Ralph Andersen,
chief health physicist at the nuclear institute.
The value -- and the limitations -- of
potassium iodide have been known to researchers for decades, and
there is little dispute on the scientific points.
Nuclear reactors produce many radioactive
substances that can harm people. One, radioactive iodine, poses
a particular worry because the human thyroid gland uses iodine
as a fundamental building block of hormones that play critical
roles in metabolism. The body cannot distinguish the safe form
of iodine present in food and table salt from the radioactive
form that comes from nuclear reactors.
It has been known since the 1950s that
young children are acutely sensitive to radioactive iodine, but
the point was illustrated dramatically when the Chernobyl nuclear
plant in Ukraine blew up in 1986, scattering radiation across
hundreds of miles.
For those living at a distance from the
plant, virtually the only known health effect has been a huge
spike in cases of thyroid cancer among children. At least 2,000
"excess" cases in Ukraine, Belarus and nearby areas
have been attributed to Chernobyl radiation. Thyroid cancer can
usually be treated, but that may require surgery, regular monitoring
and lifetime medication.
The idea behind potassium iodide is that
the thyroid gland can store only so much iodine. A potassium iodide
pill given near the time of radiation exposure floods the gland
with safe iodine and reduces or eliminates the absorption of radioactive
iodine. Potassium iodide is the same chemical used to add iodine
to table salt, but the pills contain higher doses. Anyone can
buy the pills, though they are not widely available in stores
and most people do not know about them.
Potassium iodide can protect people only
from radioactive iodine, not other kinds of radioactive fallout.
Bearing that in mind, skeptics say the much-preferred course,
in an accident, would be to get people out of the radioactive
plume or into shelters. Advocates of the drug tend to agree, they
but argue that if evacuation plans went awry, potassium iodide
would be better than nothing.
Whatever the merits of these positions,
there is no doubt that during Three Mile Island, the nation's
closest brush with nuclear disaster, the government wound up scrambling
to round up supplies of the drug at the last minute.
In that episode, a partial "meltdown"
at a nuclear plant led to the release of small amounts of radioactive
material, including iodine. For several days there was fear the
reactor would explode, and state evacuation plans turned out to
be woefully inadequate. Given the prospect of widespread radiation
exposure, the FDA decided midway through the disaster to rush
a supply of potassium iodide to Pennsylvania.
Hunkered down at an FDA emergency center,
Halperin and colleagues spent the evening of March 30, 1979, desperately
calling pharmaceutical and chemical companies. Finally Mallinckrodt
Inc. of St. Louis said it had bulk drug on hand and could package
it at a plant in Illinois. The first bottles were flown to Harrisburg
the next evening by Air Force jet.
To forestall a riot, no public announcement
was made about the drug. The emergency passed without it being
used, and eventually the stockpile grew old and was discarded.
A presidential commission that investigated
the accident, appalled by this frantic episode, recommended broad
stockpiling of the drug in the areas around nuclear reactors,
and the NRC agreed. But as memories of the emergency faded, the
agency backed out of that commitment, and the issue has been periodically
debated ever since.
Many opponents of stockpiling acknowledge
that Chernobyl provides compelling evidence of the risk of thyroid
cancer from a radiation disaster, but they say a comparable degree
of exposure would be unlikely in this country.
When Chernobyl blew up, the Soviet Union
spent days lying about the accident and failed to halt distribution
of contaminated food. There is evidence that much of the radioactive
exposure came from this failure. The radioactive iodine fell on
fields, cows ate the grass, and children drank milk from the cows.
Safety experts say the United States, by contrast, would almost
certainly move quickly to block radioactive food.
The most recent federal policy change on
potassium iodide came before the terrorist attacks of Sept. 11,
but the issue has taken on a new urgency since those attacks.
The change was initiated from within the
NRC itself. Peter Crane, then a lawyer on the agency's staff,
was a thyroid-cancer victim who thought the failure to stockpile
could not be defended. He filed a petition as a member of the
public in 1995, then spent years prodding the agency. It eventually
adopted a compromise under which it has pledged to pay for potassium
iodide for states that want it.
The NRC is still finalizing plans to implement
that policy. Meanwhile, the Health and Human Services Department
is considering buying some of the drug to add to its own anti-terrorism
stockpiles. However, there is debate about whether the drug could
be distributed from these regional stockpiles quickly enough to
do any good.
The most aggressive plan would be to follow
several European countries in distributing the drug to every household.
But American experience suggests that would be a difficult policy
to maintain over the long term. Tennessee launched such a program
in the early 1980s for people living near nuclear plants, but
participation has dropped to about 5 percent of households.
Tennessee maintains stockpiles near its
emergency shelters, however, and is confident it could make the
drug available quickly to large numbers of people.
"It doesn't seem like very much of
a burden, what we're doing," said Ruth Hagstrom, the state
health administrator who would give the order if potassium iodide
ever had to be used in Tennessee. "We're sort of happy with
the way we do things, and we wonder why everybody else doesn't
do it, too."
© 2001 The Washington Post Company
The above referred government discussions, commitments and bills
are certainly hopeful, but remember those proposed Potassium Iodide
(KI) emergency stocks are not yet in-place for any nuclear radiation
emergency today, nor for tomorrow. (With the exception of some
very limited state funded Potassium Iodide (KI) stockpiling in
Alabama, Arizona, Maine, and Tennessee. And, some recent dispensing
of a couple tablets each to residents very close to nuclear plants
in NY, NJ, and soon, California.)
Peter
Crane (Lawyer, recently retired from the U.S. Nuclear Regulatory
Commission after 20 years.) explained September 13, 1999 :
"The American Thyroid Association has been pleading
since 1989 for a more enlightened policy on KI. The World Health
Organization is moving toward recommending more aggressive intervention
with KI. The international Basic Safety Standards, to which
the U.S. is a signatory, call for KI to be part of emergency
planning. Internationally, the NRC's penny-pinching on KI is
bringing no glory to U.S. radiation protection efforts. If you
talk to doctors and radiation protection specialists from other
countries, they shake their heads in disbelief that the United
States believes it cannot afford the million or two or three
dollars it would take to bring its children's protection up
to world standards. (The international community can also see,
from the frequency with which NRC Commissioners jet around the
world, that the NRC is not completely strapped for funds.) "
Remember, too, that you must start taking Potassium Iodide (KI)
before you are exposed to attain the maximum flooding of your
thyroid with stable iodine and thus blocking subsequent uptake
of radioiodine contamination.
Unless the government not only acquires sufficient Potassium
Iodide (KI) stock for the public, but also then provides it to
each household to stock and hold themselves, so as to have it
ready on hand BEFORE a nuclear radiation emergency event, then
critical life-saving time would still be needlessly wasted trying
to distribute it during a nuclear radiation emergency. (Only about
7,500 Americans, people living within a few miles of a nuclear
power plant in Tennessee, have been given prophylactic potassium
iodide to keep in their homes. And, some recent dispensing of
a couple tablets each to residents very close to nuclear plants
in NY, NJ, and soon, California.)
Any government attempts to quickly dispense millions of doses
to the affected and frantic target populations downwind of an
ongoing nuclear radiation emergency would surely be a scene of
great panic and disarray. The resultant delays created in attempting
to distribute KI, in mass, in that fearful and anxious atmosphere
would also have unnecessarily exposed that population to even
higher radiation contaminations.
Also, read the fascinating Three
Mile Island: The Rest of the Story... (Govt. scramble to get KI
to TMI!)
Unfortunately, even that better-late-than-never potential distribution
chaos is not likely an option as, to date, the government 'stockpiles'
are currently tiny and woefully insufficient. Unfortunately, too,
you can not count on the arrival of new government Potassium Iodide
(KI) supplies being established in-place to protect your family
any time soon. (A variety of government agencies have been 'talking
about' stockpiling Potassium Iodide (KI) for public protection
ever since Three Mile Island---over twenty years ago!)
And, as Peter
Crane further details:
"As a result, we are still in a pre-Three Mile Island
state of preparedeness on KI, when the drug is routinely stockpiled
(and in some countries predistributed to individual houses)
in many European countries, including France, Germany, Switzerland,
the UK, Sweden, Norway, Austria, the Czech Republic, Slovakia,
Poland, etc., plus Japan and Canada."
Nuclear Regulatory Commission (NRC) on September 30, 1998 admitted
in COMSECY-98-016
- FEDERAL REGISTER NOTICE ON POTASSIUM IODIDE:
However, the stockpiles are limited and are not likely to provide
enough KI for use by the general public in a major radiological
emergency.
Governments world-wide are now stockpiling potassium iodide for
their citizens but, amazingly, not here in the U.S. For an insightful
and in-depth look 'behind the curtains' of the NRC KI debate,
read the full text of what Peter Crane, the recently retired lawyer
with the NRC (after over 20 years) has to say in The
NRC's "Fighter Jet Rule" on KI.
Q: Will Potassium Iodide (KI) Flush Radioactive
Iodine Out of the Thyroid Gland?
A: The question might better be; If you don't have any
Potassium Iodide (KI) and rely on the government to acquire and
distribute KI, and after some delay, you do eventually get Potassium
Iodide (KI) for your family, but it's now hours or days into the
nuclear radiation emergency, will Potassium Iodide (KI) still
help?
Yes and No.
Yes, but only to the degree your thyroid is still less than 100%
saturated with either form of iodine (radioactive or stable).
Then the Potassium Iodide (KI) will safely fill up the balance
so your thyroid will not have room for later additional uptake
of radioactive iodine.
But, No, Potassium Iodide (KI) can't flush out radioactive iodine
that's already there before taking KI.
Physicians
for Civil Defense January 1997 (vol. 13, #2) Cresson H. Kearny,
Research Engineer Retired, Oak Ridge National Laboratory and Jane
M. Orient, M.D.:
In fact, radioactive isotopes, once bound in the thyroid,
cannot be flushed out by subsequent administration of nonradioactive
iodine. To be effective in preventing the uptake and binding
of radioactive isotopes, stable iodine must be administered
before exposure. A daily 130-mg dose of stable KI, starting
one-half hour to one day before the arrival of fallout or other
material contaminated with radioactive iodine, will effectively
saturate the thyroid, giving 99% effective protection. A 130-mg
tablet or four drops of a saturated solution of KI may be used.
NCRP 65, "Management of Persons Accidentally Contaminated
with Radionuclides," (page 138) states:
"...Only about 50 percent of the uptake is blocked
if the iodide administration is delay six hours and little effect
can be achieved if the delay is more than 12 hours... If stable
iodied is given after the first 24 hours, it may sometimes prolong
the retention of iodine, since it suppressses the release of
thyroid hormone..."
Also, from the Health Physics Journal, Volume 78 No. 6, June
2000, "EFFECTS OF TIME OF ADMINISTRATION AND DIETARY IODINE
LEVELS ON POTASSIUM IODIDE (KI) BLOCKADE OF THYROID IRRADIATION
BY 131-I FROM RADIOACTIVE FALLOUT" Pat B. Zanzonico and David
V. Becker (Read abstract by searching title at Health
Physics Journal):
"KI administration 2 and 8 h after 131-I intake yields
protective effects of 80 and 40%, respectively, with iodine-sufficient
diets, but only 65 and 15% with iodine-deficient diets. KI administration
16 h or later after 131-I exposure will have little effect on
thyroid uptake and absorbed dose and therefore little or no
protective effect."
Clearly, any delay in flooding your thyroid with Potassium Iodide
(KI) is a serious risk to be aggressively avoided, especially
for your children. To depend on government KI emergency stocks
that currently don't exist and some ad-hoc untested distribution
'plan' that'll likely be chaotic, at best, can only add up to
unnecessary additional delays and radiation exposure. Add to this
having your family members possibly scattered amongst work, home,
school, etc. and all getting conflicting warnings and at varied
times, and it becomes clear that NOT already having your Potassium
Iodide (KI) in-hand could become your worst family nightmare.
BUT, it can/should be a largely avoidable disaster for your loved
ones, IF you had already acquired
your families emergency supply of Potassium Iodide (KI) and have
them on hand! (You could then also be of service to your community
in two ways: #1 - By sharing any extra Potassium Iodide (KI) supplies
with friends and neighbors and, #2 - By being one less person
standing in line in front of your other neighbors anxiously awaiting
the delayed government Potassium Iodide (KI) hand out.)
DUE TO THE LARGE SIZE OF THE FAQ,
PART 2 IS HERE... http://www.ki4u.com/FAQ-part-2.htm
OR SIMPLY CLICK ON ANY TOPIC LINK BELOW.
Printer-Friendly Complete One-Page FAQ Version
(no graphics) Here...
http://www.ki4u.com/print_me.htm
***
Quick Summary of FAQ ***