Episode 43. Poisoning of Alexander Litvinenko – “An amount the size of a grain of salt will kill a human being.”

                Chapter 11. Bop Shaplen’s thyroid cancer did not cause his death but a high dose of radiation killed him.

                Episode 43. Poisoning of Alexander Litvinenko – “An amount the size of a grain of salt will kill a human being.

  1. Evidence and analysis.
  2. On 1 November 2006, Litvinenko suddenly fell ill and was hospitalized. He died three weeks later, becoming the first confirmed victim of lethal polonium-210-induced acute radiation syndrome.[2] Litvinenko’s allegations about the misdeeds of the FSB and his public deathbed accusations that Russian president Vladimir Putin was behind his unusual malady resulted in worldwide media coverage.[3](Text 1.)
  3. “On 1 November 2006, Litvinenko suddenly fell ill. Earlier that day he had met two former KGB officers, Andrey Lugovoy and Dmitry Kovtun. Lugovoy is a former bodyguard of Russian ex-Prime Minister Yegor Gaidar (also reportedly poisoned in November 2006) and former chief of security for the Russian TV channel ORT. Kovtun is now a businessman. Litvinenko had also had lunch at Itsu, a sushi restaurant on Piccadilly in London, with an Italian officer and “nuclear expert”, Mario Scaramella, to whom he reportedly made allegations regarding Romano Prodi‘s connections with the KGB.[11](Text 1.)
  4. “Late on 22 November, Litvinenko’s heart failed; the official time of death was 9:21 pm at University College Hospital in London.[27]” (Text 1.)
  5. “In his last statement he said about Putin:

…this may be the time to say one or two things to the person responsible for my present condition. You may succeed in silencing me but that silence comes at a price. You have shown yourself to be as barbaric and ruthless as your most hostile critics have claimed. You have shown yourself to have no respect for life, liberty or any civilised value. You have shown yourself to be unworthy of your office, to be unworthy of the trust of civilised men and women. You may succeed in silencing one man but the howl of protest from around the world will reverberate, Mr Putin, in your ears for the rest of your life. May God forgive you for what you have done, not only to me but to beloved Russia and its people.[30](Text 1.)

  1. An amount the size of a grain of salt will kill a human being.” (Text 2.)
  1. Documents used for research.

(Text 1.)

Poisoning of Alexander Litvinenko

http://en.wikipedia.org/wiki/Poisoning_of_Alexander_Litvinenko

Alexander Litvinenko was a former officer of the Russian Federal Security Service (FSB) and KGB, who fled from court prosecution in Russia and received political asylum in the United Kingdom. According to his wife and father, he was working for MI6 and MI5 after receiving the asylum.

Upon his arrival to London, he continued to support the Russian oligarch in exile, Boris Berezovsky, in his media campaign against the Russian government.[1]

In the UK, Litvinenko became a journalist for a Chechen separatist site, Chechenpress. Litvinenko wrote two books, Blowing up Russia: Terror from within and Lubyanka Criminal Group, where he accused the Russian secret services of staging Russian apartment bombings and other terrorism acts to bring Vladimir Putin to power.

On 1 November 2006, Litvinenko suddenly fell ill and was hospitalized. He died three weeks later, becoming the first confirmed victim of lethal polonium-210-induced acute radiation syndrome.[2] Litvinenko’s allegations about the misdeeds of the FSB and his public deathbed accusations that Russian president Vladimir Putin was behind his unusual malady resulted in worldwide media coverage.[3]

Subsequent investigations by British authorities into the circumstances of Litvinenko’s death led to serious diplomatic difficulties between the British and Russian governments. Unofficially, British authorities asserted that “we are 100% sure who administered the poison, where and how”,[4] but they did not disclose their evidence in the interest of a future trial. The main suspect in the case, a former officer of the Russian Federal Protective Service (FSO), Andrey Lugovoy, remains in Russia. As a member of the Duma, he now enjoys immunity from prosecution. Before he was elected to the Duma, the British government tried to extradite him without success.

At the same time, Litvinenko’s father, now residing in Italy, believes Boris Berezovsky and Alexander Goldfarb were behind the murder.[5][6] Berezovsky was found dead at his home in England on 23 March 2013.

…Just two weeks before his death, Litvinenko accused Putin of ordering the assassination of Anna Politkovskaya.[10]

Illness and poisoning

On 1 November 2006, Litvinenko suddenly fell ill. Earlier that day he had met two former KGB officers, Andrey Lugovoy and Dmitry Kovtun. Lugovoy is a former bodyguard of Russian ex-Prime Minister Yegor Gaidar (also reportedly poisoned in November 2006) and former chief of security for the Russian TV channel ORT. Kovtun is now a businessman. Litvinenko had also had lunch at Itsu, a sushi restaurant on Piccadilly in London, with an Italian officer and “nuclear expert”, Mario Scaramella, to whom he reportedly made allegations regarding Romano Prodi‘s connections with the KGB.[11] Scaramella, attached to the Mitrokhin Commission investigating KGB penetration of Italian politics, claimed to have information on the death of Anna Politkovskaya, 48, a journalist who was killed at her Moscow apartment in October 2006. He passed Litvinenko papers supposedly concerning her fate. On 20 November, it was reported that Scaramella had gone into hiding and feared for his life.[12]

For several days after 1 November, Litvinenko experienced severe diarrhea and vomiting. At one point, he could not walk without assistance. As the pain intensified, Litvinenko asked his wife to call an ambulance for assistance.[13] For several weeks, Litvinenko’s condition worsened as doctors searched for the cause of the illness. Surrounded by friends, Litvinenko began to become physically weak, and spent periods unconscious. A photograph was taken of Litvinenko on his deathbed and released to the public. “I want the world to see what they did to me,” Litvinenko said.[13]

Poison

Shortly after his death, the UK’s Health Protection Agency (HPA) stated that tests had established that Litvinenko had significant amounts of the radionuclide polonium-210 (210Po) in his body. British and US government sources both said the use of 210Po as a poison had never been documented before, and this was probably the first time a person has been tested for the presence of 210Po in his or her body. The poison was in Litvinenko’s teacup; which he had just drank tea out of.[14] People who had contact with Litvinenko may also have been exposed to radiation.[15][16]

Polonium was identified only after Litvinenko’s death, on 23 November. Doctors and Scotland Yard investigators could not detect polonium earlier because it does not emit gamma rays, which are encountered with most radioactive isotopes. Unlike most common radiation sources, polonium-210 emits only alpha particles that do not penetrate even a sheet of paper or the epidermis of human skin, thus being invisible to normal radiation detectors in this case. Hospitals only have equipment to detect gamma rays. Both gamma rays and alpha particles are classified as ionizing radiation which can cause radiation damage. An alpha-emitting substance can cause significant damage only if ingested or inhaled, acting on living cells like a short-range weapon.[17] Litvinenko was tested for alpha-emitters using special equipment only hours before his death.[17]

Po-210 concentration in the body of Litvinenko

The symptoms seen in Litvinenko appeared consistent with an administered activity of approximately 2 GBq (50 mCi) which corresponds to about 10 micrograms of 210Po. That is 200 times the median lethal dose of around 238 μCi or 50 nanograms in the case of ingestion.[18]

Thallium – initial hypothesis

Scotland Yard initially investigated claims that Litvinenko was poisoned with thallium. It was reported that early tests appeared to confirm the presence of the poison.[19][20] Among the distinctive effects of thallium poisoning are hair loss and damage to peripheral nerves,[21] and a photograph of Litvinenko in hospital, released to the media on his behalf,[22] indeed showed his hair to have fallen out. Litvinenko attributed his initial survival to his cardiovascular fitness and swift medical treatment. It was later suggested a radioactive isotope of thallium might have been used to poison Litvinenko.[23] Dr. Amit Nathwani, one of Litvinenko’s physicians, said “His symptoms are slightly odd for thallium poisoning, and the chemical levels of thallium we were able to detect are not the kind of levels you’d see in toxicity.”[24] Litvinenko’s condition deteriorated, and he was moved into intensive care on 20 November. Hours before his death, three unidentified circular-shaped objects were found in his stomach via an X-ray scan.[25] It is thought these objects were almost certainly shadows caused by the presence of Prussian blue, the treatment he had been given for thallium poisoning.[21][26]

Death and last statement

Late on 22 November, Litvinenko’s heart failed; the official time of death was 9:21 pm at University College Hospital in London.[27]

The autopsy took place on 1 December.[28] Litvinenko had ingested polonium-210, a poisonous radioactive isotope.[2] Mario Scaramella, who had eaten with Litvinenko, reported that doctors had told him the body had five times the lethal dose of polonium-210.[2] Litvinenko’s funeral took place on 7 December at the Central London mosque, after which his body was buried at Highgate Cemetery in North London.[29]

On 25 November, an article attributed to Litvinenko was published by the Mail on Sunday Online entitled Why I believe Putin wanted me dead…[3]

In his last statement he said about Putin:

…this may be the time to say one or two things to the person responsible for my present condition. You may succeed in silencing me but that silence comes at a price. You have shown yourself to be as barbaric and ruthless as your most hostile critics have claimed. You have shown yourself to have no respect for life, liberty or any civilised value. You have shown yourself to be unworthy of your office, to be unworthy of the trust of civilised men and women. You may succeed in silencing one man but the howl of protest from around the world will reverberate, Mr Putin, in your ears for the rest of your life. May God forgive you for what you have done, not only to me but to beloved Russia and its people.[30]

Investigation

Initial steps

Greater London‘s Metropolitan Police Service Terrorism Unit has been investigating the poisoning and death. The head of the Counter-Terrorism Unit, Deputy Assistant Commissioner Peter Clarke, stated the police “will trace possible witnesses, examine Mr. Litvinenko’s movements at relevant times, including when he first became ill and identify people he may have met. There will also be an extensive examination of CCTV footage.”[31] The United Kingdom Government COBRA committee met to discuss the investigation.[32] Richard Kolko from the United States FBI stated “when requested by other nations, we provide assistance” – referring to the FBI now joining the investigation for their expertise on radioactive weapons.[33][34] The Metropolitan Police announced on 6 December 2006 that it was treating Litvinenko’s death as murder.[35] Interpol has also joined the investigation, providing “speedy exchange of information” between British, Russian and German police.[36]

Polonium trails

Detectives traced three distinct polonium trails in and out of London. The trails were left by Litvinenko, Andrey Lugovoy and Dmitry Kovtun. The patterns and levels of radioactivity they left behind suggested that Litvinenko ingested polonium, whereas Lugovoy and Kovtun handled it directly.[37] The human body dilutes polonium before excreting it in sweat, which results in a reduced radioactivity level. There were also traces of Po-210 found at the Hey Jo/Abracadabra bar, Dar Marrakesh restaurant, and Lambeth-Mercedes taxis.[38]

The poisoning of Litvinenko took place at around 5 pm of 1 November in the Millennium Hotel in Grosvenor Square. The bus he travelled in to the hotel had no signs of radioactivity – but large amounts had been detected at the hotel.[39] Polonium was subsequently found in a fourth-floor room and in a cup in the Pine Bar at the hotel.[40] After the Millennium bar, Litvinenko stopped at the office of Boris Berezovsky. He used a fax machine, where the radioactivity was found later. At 6 pm Akhmed Zakayev picked Litvinenko up and brought him home to Muswell Hill. The amount of radioactivity left by Litvinenko in the car was so significant, the car was rendered unusable.[37] Everything that he touched at home during the next three days was contaminated. His family was unable to return to the house even six months later. His wife was tested positive for ingesting polonium but did not leave a secondary trail behind her. This suggested that anyone who left a trail could not have picked up the polonium from Litvinenko (possibly, including Lugovoy and Kovtun).[37]

Besides Litvinenko, only two people left the polonium trails: Lugovoy and Kovtun who were school friends and worked previously for Russian intelligence in the KGB and the GRU respectively.[37] These people handled the radioactive material directly and did not ingest it, because they left more significant traces of polonium than Litvinenko.[37]

Lugovoy and Kovtun met Litvinenko in the Millennium hotel bar twice, on 1 November (when the poisoning took place), and earlier, on 16 October. Trails left by Lugovoy and Kovtun started on 16 October, in the same sushi bar where Litvinenko was poisoned later, but at a different table. It was assumed that their first meeting with Litvinenko was either a rehearsal of the future poisoning, or an unsuccessful attempt of the poisoning.[37]

Traces left by Lugovoy were also found in the office of Berezovsky that he visited on 31 October, a day before his second meeting with Litvinenko. Traces left by Kovtun were found in Hamburg, Germany. He left them on his way to London on 28 October.[37] The traces were found in passenger jets[41][42] BA875 and BA873 from Moscow to Heathrow on 25 and 31 October, as well as flights BA872 and BA874 from Heathrow to Moscow on 28 October and 3 November.[43][44]

Andrey Lugovoy has said he flew from London to Moscow on a 3 November flight. He stated he arrived in London on 31 October to attend the football match between Arsenal and CSKA Moscow on 1 November.[45] When the news broke that a radioactive substance had been used to murder Litvinenko, a team of scientists rushed to find out how far the contamination had spread. It led them on a trail involving hundreds of people and dozens of locations.[46]

British Airways later published a list of 221 flights of the contaminated aircraft, involving around 33,000 passengers, and advised those potentially affected to contact the UK Department of Health for help. On 5 December they issued an email to all of their customers, informing them that the aircraft had all been declared safe by the UK’s Health Protection Agency and would be re-entering service.

British extradition request

British authorities investigated the death and it was reported on 1 December that scientists at the Atomic Weapons Establishment had traced the source of the polonium to a nuclear power plant in Russia. On 3 December, reports stated that Britain has demanded the right to speak to at least five Russians implicated in Litvinenko’s death, and Russian Foreign Minister Sergey Lavrov asserted that Moscow was willing to answer “concrete questions.”[47] Russian Prosecutor-General Yuri Chaika said on Tuesday, 5 December that any Russian citizen who may be charged in the poisoning will be tried in Russia, not Britain.[48] Moreover, Chaika stated that UK detectives may ask questions to Russian citizens only in the presence of Russian prosecutors.[49]

On 28 May 2007 the British Foreign Office submitted a formal request to the Russian Government for the extradition of Andrey Lugovoy to the UK to face criminal charges relating to Litvinenko’s murder.[50]

…BBC programme

On 7 July 2008, a British security source told the BBC’s Newsnight programme: “We very strongly believe the Litvinenko case to have had some state involvement. There are very strong indications.”[63] The British government claimed that no intelligence or security officials were authorised to comment on the case.[64][65]

Possibly related events

On 2 March 2007, Paul Joyal, a former director of security for the U.S. Senate intelligence committee, who the previous weekend alleged on national television that the Kremlin was involved in the poisoning of Litvinenko, was shot near his Maryland home. An FBI spokesman said the agency was “assisting” the police investigation into the shooting. Police would not confirm details of the shooting or of the condition of Joyal. A person familiar with the case said he was in critical condition in hospital. It was reported that while there were no indications that the shooting was linked to the Litvinenko case, it is unusual for the FBI to get involved in a local shooting incident. A person familiar with the situation said NBC had hired bodyguards for some of the journalists involved in the program.[66]

                (Text 2.)

Polonium-210 and The Assassination of Alexander Litvinenko

Mon, 06/01/2009 – 4:00am

by Caroline DiCarlo

http://www.forensicmag.com/articles/2009/06/polonium-210-and-assassination-alexander-litvinenko

A highly active alpha particle emitter, Polonium-210 is a fatal toxin, even at very small doses.

Polonium-210 (210Po) made headlines in 2006 as the poison used to murder former Russian spy Alexander Litvinenko. Litvinenko was a KGB agent who later became an FSB (Federal Security Service) agent when Russia replaced the collapsed KGB in the early 1990s. He was given orders to assassinate an influential Russian business tycoon (whom he knew well), orders he disobeyed and then publicly exposed, among other KGB and FSB activities, on the international stage. His disclosures embarrassed the Kremlin and then-director of the FSB, Vladamir Putin. The Kremlin charged Litvinenko with treason and imprisoned him for nine months. After his release in 2000, in the wake of numerous death threats, Litvinenko and his family fled to the United Kingdom where they were granted political asylum.1

Litvinenko continued to aggressively denounce the Kremlin and Vladamir Putin, whom he accused of drug trafficking and pedophilia, perhaps naively enjoying a false sense of security inside the UK. Then, on November 1, 2006, he was mysteriously poisoned. Litvinenko’s rapid deterioration was chronicled by the international media, and he ultimately suffered for an excruciating 22 days before lapsing into a coma and dying on November 23. The toxin was identified just hours before his death as 210Po, an extremely rare substance. It is one million times more lethal than cyanide, and an amount the size of a grain of salt will kill a human being. Toxicology reports show that Litvinenko ingested more than ten times the lethal dose of the poison, indicating the resolve of his assassin to silence him once and for all.1

210Po—Radioactive and Rare
Polonium, atomic number 84, is a rare earth metal. It was discovered by Marie and Pierre Curie in 1898 while separating uranium from Bohemian pitchblende. The Curie’s found that the unrefined pitchblende was more radioactive than the isolated uranium, meaning it contained another radioactive component. They named this new element polonium, after their native land of Poland. The metal has over 25 isotopes, more than any other known element, and all are radioactive.2

210Po has unique properties that make it suitable for commercial use. The radiation emitted from one gram of the isotope generates 140 watts of heat energy, making it a desirable alternative for powering spacecraft (this is still in the research and development stages). It is currently used commercially to neutralize static electricity in machinery and to remove dust from photograph film and camera lenses.3 Production occurs in a nuclear reactor and is extremely costly, time-consuming, dangerous, and very highly regulated. A mere 100 grams are manufactured annually, mainly in Russia.1

210Po is present in the environment as a byproduct of radioactive uranium and radon decay. Although considered rare, trace amounts are ubiquitous. We are exposed to minute quantities present in soil, air, water, food, and dust.3 It is important to note that polonium itself is not the toxin, but rather the alpha particles it emits during the decay process. Alpha particles are a colorless, odorless, and tasteless form of ionizing radiation. They are very weighty and heavily charged, and can only travel a short distance (a few centimeters in air) before losing momentum. Their energy is released upon impact and therefore incapable of penetrating barriers like paper, clothing, or skin. Thus, 210Po is not dangerous in the environment per se, but is toxic if actually taken into the body.4

Exposure
Inhalation of the isotope may occur during occupational exposure or while smoking cigarettes, since atmospheric 210Po settles onto tobacco leaves.3 Deposition in the lung depends on particle size and solubility. The majority of particles are removed from the respiratory tract by mucociliary clearing and then subsequently swallowed. At that point, 210Po is reintroduced to the body as ingesta.5

Ingestion may also occur while eating in contaminated areas or through consumption of contaminated foodstuffs. For example, caribou meat, a dietary staple in northern Canada, has a high concentration of 210Po due to its presence in the lichens they eat.6 In general, only a small fraction of the isotope is absorbed following ingestion, with as much as 90% being quickly excreted from the body in the feces.3

Dermal or parenteral exposure to 210Po is unlikely. While dust or aerosolized particles may deposit on skin and clothing, alpha particles cannot penetrate these barriers since most of their energy is lost on impact. The particles can, however, enter through open wounds and absorb subcutaneously.7 Parenteral access does not typically occur accidentally or occupationally, but is a common route of entry in medical procedures and in clinical research.2

Once 210Po is taken in, the whole body is essentially targeted. The administered dose and individual tissue sensitivity determines the extent of damage throughout the body.2 Unlike most heavy metals, 210Po accumulates in soft tissue rather than bone.8 There is species variation with regard to distribution, but for the most part, the kidneys, liver, and spleen contain the highest concentrations. In blood, the majority of the isotope is found in the red blood cells, bound to hemoglobin. Its binding to the globin component rather than heme indicates an affinity for proteins. Very little is found in aggregates with plasma or erythrocyte lipids. Deposition seems to depend somewhat on route of entry, with a much higher concentration in the blood after oral administration and in the kidney and spleen after intravenous administration.8

210Po is primarily eliminated in feces and urine. Older data asserts that following oral administration, 90% of the ingested isotope is rapidly excreted in the feces.8 This conflicts with newer experimental findings which put the fecal excretion rate at 55–69% and renal elimination at 20–38%. The newer study also found that the biological half-life of polonium-210 varies from 15–50 days depending on the species.5 The isotope may be eliminated through the sweat glands as well, although clearance by this route is minimal.9

Following the Trail
210Po has a radiological half-life of 139 days. It disperses over time, contaminating the environment and leaving a trail behind, a unique property called “creeping.”2 This quality, coupled with the availability of detection and quantification devices, allowed authorities to retrace Litvinenko’s footsteps on November 1, 2006, in order to establish where he was poisoned.

He began the day with a bus ride into London, where he stopped at a shop for a paper and bottle of water. He then met Italian nuclear waste and security consultant Mario Scaramella for sushi. Tests indicated no 210Po on the bus, the ticket, or in the shop where he bought the paper and water. There were, however, traces of the poison found in the sushi restaurant, but not at the table where he and Scaramella ate.1

Litvinenko then met with Boris Berezovsky, the man he refused to assassinate years before. He warned Berezovsky of yet another assassination order, information provided by Scaramella. Samples taken from Berezovsky’s office tested positive for trace amounts of 210Po.1

Next, Litvinenko went to the Millennium Hotel where he met Andrei Lugovoi, a former KGB agent, and Dmitri Kovtun to discuss possible business ventures. Litvinenko drank tea during the meeting. Samples from the bar showed levels of 210Po that were “off the charts.”1 Litvinenko’s tea cup was contaminated, as were many of the hotel employees. For these reasons, investigators believe this is where he was poisoned.10

The evidence points to Lugovoi and Kovtun. Traces of 210Po were detected virtually everywhere they went: their planes to London; the hotels where they stayed; the sushi restaurant (Litvinenko met them there two weeks prior to meeting with Scaramella); Berezovsky’s office (the two men had paid him a visit); and the London stadium seat where Lugovoi sat during a Russian football match. Furthermore, both men tested positive for 210Po exposure upon returning to Russia and were subsequently hospitalized. Despite this evidence, both Lugovoi and Kovtun vehemently deny the allegations and insist they were framed.1

210Po Symptoms and Diagnosis
The clinical manifestations of 210Po poisoning are those of radiation sickness. Dose-dependent effects follow those of acute radiation syndrome (ARS). In non-lethal doses (<1 sievert), the individual is typically asymptomatic or has very mild clinical manifestations. Approximately 1–10% of individuals experience intermittent nausea and vomiting, and there may be a slight decrease in white blood cells after two to four weeks. Highly toxic doses (4.5 sieverts) cause nausea, vomiting, anorexia, and lethargy within hours, with a latent period of days to weeks before the onset of more severe symptoms. Loss of bone marrow, white blood cells, and platelets results in infection, bleeding, and bruising. Hair loss occurs in two to three weeks. If left untreated, 50% of individuals will die. At 10 sieverts, 100% of individuals will die within two weeks. At >20 sieverts, clinical manifestations occur almost instantly. Symptoms include projectile vomiting, explosive bloody diarrhea, headache, fainting, confusion, agitation, and burning sensations. Cardiovascular symptoms and neurological deficits ensue, followed by shock, seizures, coma, and death in two to three days.4

Ultimately, the damage caused by 210Po alpha particles is due to total body irradiation. This results in extraction of electrons, disruption of cellular structure and activity, fragmentation of nuclei, chromosomal damage, as well as tumor induction. Some cells are more sensitive than others to these injuries, particularly bone marrow, lymphocytes, and enterocytes. Extremely high levels of ionizing radiation overwhelm the mechanisms of cell repair, and mass cell death occurs throughout the body, as seen in the case of Alexander Litvinenko.11

Diagnosis of 210Po poisoning is often delayed by the presence of non-specific gastrointestinal maladies that mimic food poisoning or the flu. Consequently, appropriate treatment is not always pursued at the onset of symptoms. Suspected exposures are confirmed through diagnostics. Fecal specimens are often used to determine exposure and, to a lesser extent, clearance rates. A more likely test for tracking the elimination rate of the isotope is a 24-hour urine assay. Quantification in urine cannot, however, predict the total systemic dose received or tissue concentrations. This is also true for fecal specimens.5 Analysis of blood is more useful for this purpose. A simple radiochemical and counting technique is used to measure the concentration of 210Po in the sample, which correlates to total body burden. The concentration of the decay product (lead) is also quantifiable and aids in determination of total body concentration.12

Chronic low-dose exposure to 210Po can likewise be determined from radiochemical analysis of urine. The results are then compared to previously established tolerance levels. This type of testing occurs when there is a risk of occupational exposure. Employees are tested monthly and the results used to direct modifications in usage or handling protocols.5

210Po is quantifiable in hair samples. It is secreted by the sweat glands and then retained in the hair follicle. Like blood, urine, and fecal specimen analysis, alpha particles are counted radiochemically in order to determine total body burden and clearance rates. It is a practical method for chronic low-dose monitoring rather than acute poisoning. However, as is the case with urine and fecal analysis, concentrations cannot predict activity in specific tissues.9

Summary
210Po is a highly active alpha particle emitter, but is only toxic if it enters the body. If entry does occur, the toxic effects are often fatal, even at very small doses. Much of the initial dose is quickly excreted in the feces and urine, but the remainder is preferentially distributed to the soft tissues of the body. The kidney, liver, and spleen receive the highest concentrations, while the skeletal system receives very little, atypical for a heavy metal. Exposure to 210Po is confirmed through diagnostics. Fecal and hair samples are good indicators of exposure. A 24-hour urine assay is effective for determining clearance rate, and blood analysis can predict total body burden. Clinical manifestations of 210Po poisoning are essentially identical to acute radiation syndrome (ARS), often mimicking food poisoning or the flu. Delays in diagnosis may occur for this reason. As soon as 210Po is identified as a possible toxin, medical management should follow as indicated for ARS. Measures should be taken immediately to prevent cross-contamination from the patient’s self, clothing, and bodily fluids.

There is no known antidote for 210Po poisoning. While chelating agents may potentially increase clearance rates, they are not antidotes. Furthermore, chelation therapy is not always initiated quickly enough to prevent significant morbidity or death. Death occurs after total body irradiation, massive cell death, infection, and complete organ failure.

The murder of Alexander Litvinenko did little for diplomatic relations between the United Kingdom and Russia, but it did bring a rare earth metal into the spotlight. Litvinenko’s murder is still considered unsolved, though Scotland Yard believes Andrei Lugovoi carried out the assassination at the command of the FSB. Diplomatic relations between the UK and the Kremlin have suffered, suggesting the effects of Litvinenko’s death could reverberate for years to come and influence the course of international affairs. Questions still remain that may never be answered, and it is unlikely that justice will ever be delivered.

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