Radiation Disasters And Children: Why No Potassium Iodide Now

There is a lot of talk about radiation and radiation effects because of the ongoing tragedy in Japan. It’s a bit overwhelming and confusing, to say the least. Ultimately, fear motivates us to act in bizarre ways and this current catastrophe in Japan is no exception. I find myself a bit nauseated when my mind drifts to Japan, yet I can’t seem to curb the urge to watch the updates. I don’t normally watch live news because I sincerely don’t think it’s good for me. But this horrific human tragedy steals me away from my typical distance while simultaneously reminding me of two quotes, one posted earlier:

Disasters are about people and planning, not nature’s pomp.” ~The Economist
and
Human inability to detect radiation can pose more of a psychological threat than a physical one. ~The Washington Post

The ongoing tragedy in Japan will help motivate us to prepare. But fear of the unknown can eat away at us, too. Anxiety surrounding Japan’s struggle may be higher than what we experience typically with catastrophic events, in part because of the complexity in understanding the effects of radiation. Because radiation is invisible to the eyes and undetectable to the nose, its presence is difficult to detect. We know that fear and anxiety are common in children affected by natural and radiation disasters but its psychological effect may be the most lasting and intrusive to health.
We can do things to protect our health, too. First, if your children are watching TV, sit with them and provide honest, age-appropriate explanations. Turn the TV off whenever possible. Next, discuss what your family is doing to help prepare for unexpected emergencies. Preparing your home and family for disasters with both a communication plan and an emergency kit can be a great way to decrease anxiety for both you and your children and will arm them with tools to protect themselves. A great antidote to fear is to regain your sense of control. I hope this post, and ongoing ones, help us all calm down.
The bottom line is this: with what we know now about Japan’s current disaster, even with the possible worsening nuclear crisis, medical countermeasure such as potassium iodide (KI) are not indicated here in the US. Don’t pop the Potassium Iodide (KI). And don’t feed it to your kids! Although Japan is advising KI use in the close vicinity to the damaged reactors, the US Nuclear Regulatory Agency and the Washington State Department of Health have both said that harmful effects of radiation are not expected in Hawaii or the US West Coast.
I believe every decision we make in medicine is a balance between risk and benefit, from intervention to doing nothing. This radiation question is no exception. Potassium iodide can protect the thyroid gland from the devastating effects of high levels of ionizing radiation. But, when used inappropriately or unnecessarily, potassium iodide has the potential to cause very serious side effects such has abnormal heart rhythms, bleeding, nausea, vomiting, and electrolyte abnormalities.
The risk of using KI far exceeds any benefit right now.
Potassium iodide is an over the counter commercially available medication. Don’t let it’s “over-the-counter” status confuse you into thinking it’s a harmless substance; ingesting KI can be dangerous. KI should always be stored up and out of reach of children.

Radiation Effects In Children, Use of KI, And Calming Down:

• What you’ll read here will echo what you’ll read elsewhere. I am learning from health leaders in the Department of Health and from the American Academy of Pediatrics; both will help us understand more as time goes on. Further, I never received much training about potassium iodide or remember learning much about its use in children during med school or residency. So I’ve been doing a lot of reading, listening, and learning about this topic to help advise my patients. If your pediatrician is also learning in the moment, I wouldn’t be surprised.
• What Is Radiation? “We live in a radioactive world–humans always have,” says the American Nuclear Society. We get radiation from natural and man-made sources every single day. It comes from as far away as outer space, and from as near as the foods we eat and the water we drink. There are two kinds of radiation events that can cause noted negative health effects in children: First, gamma rays and neutrons from a nuclear weapon. Fortunately, the exposure decreases as distance from the bomb increases. This type of radiation can hit the body unless you are protected by a wall. Secondly, internal radiation from fallout of radioactive elements (like that from Japan) that can enter the body via inhalation and ingestion. After a nuclear event, radioactive iodine can enter the air and be inhaled. It also can land on produce or feed for animals. After ingestion, some elements can concentrate in parts of the body. For example, radioiodine, one of the substances released from reactors in Japan, can concentrate in the thyroid, a gland in your neck, and have dangerous effects. After Chernobyl, we learned a significant source of fallout is often in cow’s milk that children (and adults) drink. We know now to avoid this particularly dangerous ingestion. Read a summary on radioactive fallout by The National Cancer Institute.
• Is Radiation Worse For Kids? Yes. After studying the effects of the A-bomb in Japan and the fallout from Chernobyl, we know that children are much more vulnerable to the effects of radiation, partly because they absorb and metabolize substances differently and because they are closer and interact more with the ground, where fallout would settle. Further, because of high concentrations in cow’s milk, children (big milk drinkers) are at increased risk. Ultimately, radiation can damage cells in the body. Therefore, we always want to reduce any radiation exposures, particularly in kids.
• What is Potassium Iodide (KI) And How Does It Work? In 1982, the US FDA approved potassium iodide (KI) to protect the thyroid gland from radioactive iodine arising from radiological or nuclear emergencies. In a radiation event like in Japan or in attack on a nuclear power plant, or in nuclear bomb fallout, volatile fission product (radionuclides and radioactive iodine) can be released. Once in the air, we can ingest or inhale this dangerous iodine. KI works by preventing radioactive iodine from reaching the thyroid. By saturating the thyroid gland with a source of stable iodide (KI, for example) prior to any exposure to these radioactive iodines, the ionizing radiation tends to be excreted from the body instead of being absorbed. The protective effect of KI dose lasts approximately 24 hours. The CDC reviews KI and discusses proper dosages for infants, children, pregnant and breast feeding moms. I’m not spending a lot of time on dosing and use right now because I don’t think we need to use it. If we do, I’ll write a more detailed post.
• Does KI Protect The Entire Body? No. KI neither protects against radiation poisoning elsewhere in the body nor can it provide any degree of protection from bombs producing radionuclides other than radioisotopes of iodine.
• Do Americans Need KI? Typically, no. However, if you live within 10 miles of a nuclear reactor, you should have doses available for all family members, especially children. For the rest of us who don’t live in proximity of a reactor, No, we don’t need it now due to events in Japan. Further, take a look at this graphic from NYT showing the moving plume. By the time that the radioactive particles from Japan reach the West coast, they are largely dispersed. Also, note that it takes about 6 days for the plume to reach the west coast.  The half life of I-131 is very short, only 8 days. This means every 8 days, its dose is reduced in half. Therefore, much of the plume that arrives has already lost its intensity just because of time. In addition to time, wind dispersal reduces its potency. After 80 days, less than 1% of radioactive particles will remain.
• Radiation Levels Now: As of writing this on March 18th, no increase in radiation levels have been detected here. Federal and state agencies are monitoring radiation levels and detect no noted changes. And detection efforts have been increased. Further, samples taken 50 miles from the reactors in Japan are currently not at harmful levels. In Washington state, as of today, follow radiation levels online.
• Is This Radiation The Same As Radiation From A Doctor Ordered X-ray? Yes and No. Both diagnostic x-rays and the radiation plume  from Japan are ionizing radiation. However, the bulk of the fission products in a nuclear fall out are I-131 type radiation. Most particles produced by this type of radiation travel a very short distance. In contrast, in the clinic or hospital, I-131 is used only in rare circumstances, typically in the detection and treatment of thyroid cancers.
• How do the radiation levels near the nuclear site compare to a chest x-ray? Not well. Although the standard unit of measurement for ionizing radiation is a millirem (mrem), it may be difficult to compare effects in Japan to a chest x-ray here. A chest x-ray or a CT scan gives you a set amount of radiation over a very short period of time (seconds).  Radiation levels in an around the nuclear plant in Japan are measured in radiation/hour. Only in a very complicated interventional radiology procedure would a patient be exposed to an hour of ongoing radiation.  Physicians work hard to reduce time of x-ray exposures, ie a campaign called Step Lightly. FYI: I got a little help with these last few points from my husband, a radiologist. Read more about reducing radiation exposure for your kids in his guest blog.
• Anxiety: As I said earlier, fear of the unknown is unsettling, particularly when our senses don’t back us up in detection of harmful substances. The most damaging effect of these tragedies for many of us here may likely be psychological. Do your best to turn off the TV when possible. Access information daily as opposed to hourly. Explain to your children what you see and what it means. Reassure them that you’re doing everything you can to prepare for unexpected events in your household and community. Build a 3 day emergency kit and make a communication plan for your family. Do this now. Your anxiety will only diminish…

What did I miss? What questions do you have?

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