Managing Depleted Uranium

Injuries
(courtesy
Col Lawrence R. Whitehurst, M.D., FAAFP)
 Depleted Uranium
• Depleted uranium is naturally occurring
uranium that has been “depleted” of the isotope
235U (The 235U is used in nuclear reactors)

• Common component in many munitions and

ballast (everything from shells and shell
casings to counterweights on C-141 ailerons)
• Low specific activity (an alpha emitter with a
half life of 4.8 billion years)
• Serious hazard to patients (hit by KE
weapons) - not to health care workers!
 Types of Ionizing Radiation
Radiation Electrical Tissue RBE Shielding
Type Charge Penetration Material

Alpha +2 <1 mm 20 paper

Beta -1 or +1 few mm 1 clothing

no
Gamma 0 limit 1 lead
few cm
Neutron 0 to 1 m 1-10 water
 Alpha Particles
• A “naked” helium nucleus - 2 protons, 2
neutrons; double positive charge
• Heavy - Atomic weight of 4
• Easy to stop - 2 sheets of notebook paper will
stop even the most powerful alphas
• Most damaging form of radiation in tissue
• Major health risk is from penetrating
wounds, inhaling, or ingesting alpha emitters
 Types of Injuries with DU
• Minor cuts and abrasions
• Lacerations
• Fractures
• “In and out” penetrating wounds
• Burns
• Inhalation injuries from burning DU
• Various size embedded fragments of DU
 Hazards of DU
• Kinetic (very heavy, very dense fragments
do lots of damage when they strike tissue)
• Thermal (the stuff burns)
• Low level Radioactivity
• Toxic - this is the ultimate “heavy metal”
– Chemically acts like arsenic and other heavy
metals
• Large ingestions or multiple embedded
fragments may cause kidney failure!
 Clinical Management
• Do not delay extraction, treatment or
evacuation due to the presence of DU
• Use standard precautions to protect health
care workers from accidental exposure
• Clean and debride wounds using standard
surgical procedures
• Plain x-ray films will show even very small
fragments because of their high density
• Unless surgically contraindicated, all DU
fragments > 1.0 cm should be removed
 Management (cont.)
• A standard ADM-300 or AN/VDR-2 Radiac
meter with the beta window open will help
locate DU fragments
• Do not delay debridement and wound care
waiting for Radiac monitoring
• Kidney functions should be routinely
monitored for patients with DU wounds,
especially if all fragments cannot be removed
 Kidney Functions
• Recommended tests include: Urinalysis
– Urine Uranium levels
• Assistance available through:
• Institute for ESOH Risk Analysis,
• Radiation Surveillance Division
• Brooks AFB, TX 78235, DSN 240-2061
– Serum BUN
– Serum Creatinine
– Beta-2-Microglobulin
– Creatinine Clearance
 Public Health Concerns
• These patients must be identified and tracked
• Presence of DU fragments presents no risks to
family members, co-workers, or health care
workers
• Body fluids from these patients are no more
hazardous than normal
• No special precautions are required for
anyone having contact with these patients
 Identification and
Documentation
• If DU internalization or wounding is
suspected, document it on the Field Medical
Card (DD Form 1380, block 14)
• Annotate what the service member was doing
when injured
• Annotate the results of urine tests or Radiac
monitoring
• Annotate what treatment the patient received
• 24-hour Urine Uranium level most
sensitive test to determine internalization
 Follow-up

• These patients require periodic follow-up,

especially if fragments are left in place
• Follow up procedures include interval
histories, blood counts, and urine testing
• Report these patients to the VA by
documenting their DU internalization on their
problem lists (AF Form 1480A)
• Always include this diagnosis on any MEB