Edit concept Question Editor Create issue ticket

Acute Radiation Sickness

Acute radiation sickness occurs to subjects after exposure to internal and external radiation. Major nuclear plant catastrophes are best descriptive of possible situations where high dosage of radiation may come in contact with a human body and develop this disease.


Presentation

Acute radiation sickness (ARS) or acute radiation syndrome negatively influences all organ systems, especially that of the hematopoietic system. The reason for it is the dependence on stem cells that are primarily affected in a situation of acute radiation exposure. Ionizing radiation causes damage to double-stranded DNA molecules resulting in the loss of proliferative function and damage to affected cells [1].

Acute radiation sickness expresses itself in three phases: prodromal, latent and manifestation phase.

The prodromal phase includes symptoms of the gastrointestinal (GI) tract such as nausea, vomiting, and diarrhea with consequent fluid, electrolyte loss, and anorexia. Non-specific symptoms like a headache, hypotension, fever, erythema are also present [2]. It is important to differentiate these symptoms from those of GI infections or other pathologies involving this system.

The latent phase is characterized by the discontinuation of symptoms seen in prodromal phase or mild exhibition of them. The duration of this phase is dependent on the dose of radiation certain subject was exposed to [2].

Manifestation phase follows after latent phase. The manifestation of ARS involves multiple organ systems, firstly that of the hematopoietic system [3].

  • Hematopoietic syndrome takes place if the dose of exposure is in a range of 2-3 grays (Gy) [4]. Consequences of this syndrome are based on depletion of blood cells i.e. thrombocytopenia, leukopenia, and anemia [5].
  • Cerebrovascular syndrome results from inflammation and damage to the blood vessels. The symptoms of this syndrome are cognitive impairments like disorientation, confusion, seizures and loss of balance. On examination, patients may be ataxic or have signs of papilledema. The absence of deep tendon and corneal reflexes is also noted [5].
  • GI syndrome includes symptoms listed in prodromal phase in addition to abdominal cramps. Additionally, there is a serious risk of infections as a result of disturbances in mucosal barrier. Leukopenia caused by the hematopoietic syndrome too increases predisposition to infection. Destruction of mucosa can also lead to bleeding from GI tract, enhancing the presentation of anemia [5].
  • In early stages, cutaneous syndrome manifests as erythema and edema. In contrast, late in the disease, signs like desquamation, ulceration, and onycholysis become evident [5] [6].

More serious complications of severe cases in ARS are accountable for systemic inflammatory response syndrome (SIRS) with following multi-organ failure (MOF) [1].

Fever
  • Non-specific symptoms like a headache, hypotension, fever, erythema are also present. It is important to differentiate these symptoms from those of GI infections or other pathologies involving this system.[symptoma.com]
  • The hematopoietic syndrome occurs at 1-8 Sv, and is characterized by the following clinical signs and symptoms: 2 Nausea, vomiting, and diarrhea Mucositis, skin erythema, and fever Lymphocytopenia within 48 hours, neutropenia, and thrombocytopenia within[upmc-cbn.org]
  • Symptoms Mild (1-2 Gy) Moderate (2-4 Gy) Severe (4-6 Gy) Very Severe (6 Gy) Lethal ( 8 Gy) Phase Symptoms Time to Onset 30 days 18-28 days 8-18 days 7 days 3 days Clinical Manifestations Fatigue Fever High Fever High Fever High Fever Weakness Weakness[large.stanford.edu]
  • The bone marrow syndrome is characterized by anorexia (lack of appetite), fever, and malaise. There is a drop in all blood cell counts for several weeks. The primary cause of death is infection and hemorrhage.[medicinenet.com]
  • Some symptoms that are common with radiation sickness include nausea and vomiting, headache, fever, dizziness, disorientation, fatigue, bloody vomit and stools, hair loss, low blood pressure, and poor wound healing.[wikihow.com]
Anemia
  • Destruction of mucosa can also lead to bleeding from GI tract, enhancing the presentation of anemia. In early stages, cutaneous syndrome manifests as erythema and edema.[symptoma.com]
  • […] characterized by the following clinical signs and symptoms: 2 Nausea, vomiting, and diarrhea Mucositis, skin erythema, and fever Lymphocytopenia within 48 hours, neutropenia, and thrombocytopenia within 20-30 days Impaired wound healing, bleeding, and anemia[upmc-cbn.org]
  • Following a latent period of six months to one year after extremely high does of radiation, protein in the urine, kidney insufficiency, anemia and high blood pressure may develop.[rarediseases.org]
  • It can dramatically reduce the number of red blood cells, causing anemia and and increased risk of fainting. Credit: istockphoto Radiation sickness can cause visible ulcers in or on the mouth.[cbsnews.com]
  • Clinical Symptoms of Acute Radiation Syndrome (Open Table in a new window) Acute Radiation Syndrome Clinical Symptoms 0.7 Gy Hematopoietic syndrome - anemia, neutropenia 10 Gy Gastrointestinal syndrome - nausea, vomiting, dehydration, weight loss, anorexia[emedicine.medscape.com]
Malaise
  • Acute radiation sickness is characterized by nausea, vomiting, diarrhea, anorexia, headache, malaise and rapid heartbeat (tachycardia). With mild ARS, the discomfort subsides within a few hours or days.[rarediseases.org]
  • The bone marrow syndrome is characterized by anorexia (lack of appetite), fever, and malaise. There is a drop in all blood cell counts for several weeks. The primary cause of death is infection and hemorrhage.[medicinenet.com]
  • […] syndrome to appear Length of the prodromal period of hematologic syndrome Length if the latent period of hematologic syndrome Declines during the latent period of hematologic syndrome although there are no other signs of illness Vomiting, diarrhea, malaise[quizlet.com]
  • Systemic reactions to radiation include a general feeling of malaise, loss of appetite or nausea and vomiting, and headache.[medical-dictionary.thefreedictionary.com]
  • The signs and symptoms of acute radiation poisoning are: vomiting, diarrhea, and nausea loss of appetite malaise, or feeling unwell headache rapid heartbeat Symptoms depend on the dose, and whether it is a single dose or repeated.[medicalnewstoday.com]
Weight Loss
  • Clinical Symptoms of Acute Radiation Syndrome (Open Table in a new window) Acute Radiation Syndrome Clinical Symptoms 0.7 Gy Hematopoietic syndrome - anemia, neutropenia 10 Gy Gastrointestinal syndrome - nausea, vomiting, dehydration, weight loss, anorexia[emedicine.medscape.com]
  • Third-stage symptoms are fever, infection, vomiting, bloody diarrhea, hemorrhages, dehydration, weight loss, hair loss, and ulcers. Death usually occurs in this phase if the damage has been sufficiently severe.[britannica.com]
Vomiting
  • For example, damage to the GI is scored by evaluating the time of onset, severity, the frequency of vomiting or diarrhea.[symptoma.com]
  • Following a dose higher than 2 Sv, most people will vomit.[upmc-cbn.org]
  • Medications should be administered to treat symptoms like vomiting, diarrhea, pain and burns. Fluids, electrolytes and nutrition should be maintained. Psychological support should also be offered to these patients.[medindia.net]
  • The diagnosis of ARS was initially considered for 237 persons based on symptoms of nausea, vomiting, and diarrhea. Ultimately, the diagnosis of ARS was confirmed in 134 persons.[ncbi.nlm.nih.gov]
Nausea
  • The diagnosis of ARS was initially considered for 237 persons based on symptoms of nausea, vomiting, and diarrhea. Ultimately, the diagnosis of ARS was confirmed in 134 persons.[ncbi.nlm.nih.gov]
  • The prodromal phase includes symptoms of the gastrointestinal (GI) tract such as nausea, vomiting, and diarrhea with consequent fluid, electrolyte loss, and anorexia.[symptoma.com]
  • These include the prodromal phase where the patient suffers from symptoms like nausea, vomiting and diarrhea, a latent phase where the patient shows apparent recovery, a manifest illness phase where most of the symptoms appear, and a fourth phase of either[medindia.net]
  • The hematopoietic syndrome occurs at 1-8 Sv, and is characterized by the following clinical signs and symptoms: 2 Nausea, vomiting, and diarrhea Mucositis, skin erythema, and fever Lymphocytopenia within 48 hours, neutropenia, and thrombocytopenia within[upmc-cbn.org]
Diarrhea
  • For example, damage to the GI is scored by evaluating the time of onset, severity, the frequency of vomiting or diarrhea.[symptoma.com]
  • Medications should be administered to treat symptoms like vomiting, diarrhea, pain and burns. Fluids, electrolytes and nutrition should be maintained. Psychological support should also be offered to these patients.[medindia.net]
  • The diagnosis of ARS was initially considered for 237 persons based on symptoms of nausea, vomiting, and diarrhea. Ultimately, the diagnosis of ARS was confirmed in 134 persons.[ncbi.nlm.nih.gov]
  • The hematopoietic syndrome occurs at 1-8 Sv, and is characterized by the following clinical signs and symptoms: 2 Nausea, vomiting, and diarrhea Mucositis, skin erythema, and fever Lymphocytopenia within 48 hours, neutropenia, and thrombocytopenia within[upmc-cbn.org]
Loss of Appetite
  • Initial symptoms of Acute Radiation Sickness occur within 1 hour to 2 days of exposure and include: Nausea Vomiting Anorexia (loss of appetite) Diarrhea If you experience any of these symptoms following exposure to radiation, it is CRITICAL that you seek[potassiumiodide.com]
  • These symptoms include loss of appetite, fatigue, fever, nausea, vomiting, diarrhea, and possibly even seizures and coma. This seriously ill stage may last from a few hours up to several months.[emergency.cdc.gov]
  • During the prodromal period patients might experience loss of appetite, nausea, vomiting, fatigue, and diarrhoea; after extremely high doses, additional symptoms such as fever, prostration, respiratory distress, and hyperexcitability can occur.[health.gov.au]
  • Systemic reactions to radiation include a general feeling of malaise, loss of appetite or nausea and vomiting, and headache.[medical-dictionary.thefreedictionary.com]
  • Other symptoms can include diarrhea, weakness, fatigue, loss of appetite, fainting, dehydration, inflammation of tissues, bleeding from the nose, mouth, gums or rectum, and anemia.[cbc.ca]
Blood in Stool
  • Possible symptoms may include: Headache Diarrhea Fever Vomiting and nausea Dizziness Ulcers of the mouth Redness and swelling of exposed areas Sloughing of the skin Open wounds on the skin Blood in stool Bleeding from the rectum, mouth, nose, and gums[syndromespedia.com]
Alopecia
  • Erythema The correct order of layers of skin, from outermost to innermost: Epidermis, Dermis, Subcutaneous The skin erythema dose necessary to affect 50% of the people irradiated is termed: SED50 The SED50 is estimated to be approximately: 600 Epilation or alopecia[studystack.com]
  • Moderate exposure may cause headache, nausea, vomiting, anorexia, and diarrhea; long-term exposure may result in sterility, fetal damage in pregnant women, leukemia or other forms of cancer, alopecia, and cataracts. radiation sickness The generic term[medical-dictionary.thefreedictionary.com]
Subcutaneous Nodule
  • الصفحة 729 - Rheumatoid nodules Subcutaneous nodules, over bony prominences, or extensor surfaces, or in juxta-articular regions, observed by a physician. 6. Serum rheumatoid factor Demonstration of abnormal amounts of serum rheumatoid factor... ‏[books.google.com]
Delusion
  • الصفحة 758 - A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other. ‏[books.google.com]
Epistaxis
  • […] entering an irradiation chamber when the source is unshielded); history of proximity to an unknown (usually metallic) object with a history of nausea and vomiting, especially if nausea and vomiting are unexplained by other causes; tendency to bleed (epistaxis[health.gov.au]
Papilledema
  • On examination, patients may be ataxic or have signs of papilledema. The absence of deep tendon and corneal reflexes is also noted. GI syndrome includes symptoms listed in prodromal phase in addition to abdominal cramps.[symptoma.com]

Workup

It is possible to assess acute radiation sickness with a proposed medical treatment protocols for radiation accident victims (METREPOL). It is convenient in distinguishing affected organ systems based on clinical presentation. The protocol calculates severity and possible damage done to the neurovascular, gastrointestinal, cutaneous and hematopoietic systems. For example, damage to the GI is scored by evaluating the time of onset, severity, the frequency of vomiting or diarrhea [7] [8]. A score of 1 is given to a patient who does not need acute medical attention and should be referred to an outpatient clinic for further follow ups. A score of 2 is given to a patient who is in high need of professional care. And a score of 3 is given to those who are likely to suffer from multiple organ failures (MOF) and have an overall low risk of survival [7] [8].

Blood tests are of paramount importance to control the dynamics of the patient as the hematopoietic system is greatly radiosensitive. To achieve proper care, repeated blood count of granulocytes, platelets, and lymphocytes are needed about every 6 hours for the first 24h and reticulocyte count every 24h [5]. Standard biochemical tests are also necessary. If there is suspicion of radionucleotide ingestion, the analyses of urine and feces will provide appropriate evidence [5].

Biodosimetry of chromosome aberrations in lymphocytes is useful in determining the possible dose of radiation, as the severity of aberrations strongly correlate to the dosage of radiation given [5]. During biodosimetry, analysis of translocations, dicentrics and chromosome consolidations are sought [9].

Physical dosimetry is convenient for providing analysis for individual dose taken but is a technique limited in availability. It is also possible to obtain high-quality radiation dosage data from an in vivo electron paramagnetic resonance (EPR) dosimetry that works by evaluating nail or teeth [10].

Treatment

  • As part of the comprehensive treatment, strict reverse isolation and granulocyte-macrophage colony-stimulating factor (GM-CSF) therapy were applied. All the patients recovered after an appropriate treatment for 83 days.[ncbi.nlm.nih.gov]
  • While low doses of radiation do not merit treatment and high doses are lethal regardless of treatment, intermediate doses can be survivable if proper treatment is initiated.[upmc-cbn.org]
  • Long term treatment has included therapy for beta burn fibrosis and skin atrophy as well as for cataracts.[ncbi.nlm.nih.gov]
  • Internal contamination was of relatively minor importance in treatment. By the end of 2001, an additional 14 ARS survivors died from various causes.[journals.lww.com]
  • Potential for a pluripotent adult stem cell treatment for acute radiation sickness. World J Exp Med 2, 37-44. Google Scholar PubMed Log in or register to post comments[stembook.org]

Prognosis

  • Table 1 stratifies the risk and prognosis from radiation exposure based on lymphocyte counts 48 hours after exposure. 2 Table 1: Lymphocyte Counts and Prognosis 48 hr. lymphocyte count Est'd radiation dose Prognosis 1000-1500 cells/mm 3 1-2 Sv Good 500[upmc-cbn.org]
  • The higher the dose of radiation, the sooner these symptoms appear - and the worse the prognosis. Someone who starts to vomit within one hour of exposure is likely to die.[cbsnews.com]

Epidemiology

  • What is feasible and desirable in the epidemiological follow-up of Chernobyl. In: A. Karaoglou, G. Desmet, G.N. Kelly & H.G.[keynes.scuole.bo.it]
  • A subset of the Life Span Study (the Adult Health Study) is examined clinically every two years; this clinically examined subset also forms the basis of cytogenetic, immunological, and molecular epidemiologic studies.[stat.ucla.edu]
Sex distribution
Age distribution

Pathophysiology

  • With supportive therapy, people who have been exposed to levels as high as 5-6 Sv can survive. 1 ARS refers to a spectrum of pathophysiological effects that are induced when high doses of ionizing radiation interact with the human body.[upmc-cbn.org]

Prevention

  • Infections should be prevented and treated with antibiotics. Medications should be administered to treat symptoms like vomiting, diarrhea, pain and burns. Fluids, electrolytes and nutrition should be maintained.[medindia.net]
  • Radiation Exposure Injuries The tables below show the symptoms that manifest with localized cutaneous radiation injury, acute radiation syndrome, and lethal doses of radiation according to the Centers for Disease Control and Prevention. [1, 2] Table 1[emedicine.medscape.com]
  • Not only did the drug prevent the destruction of the intestinal barrier cells, it boosted biomarkers characteristic of cell repair.[popsci.com]
  • Orphan designation had been granted in the United States for preventing death following a potentially lethal dose of radiation in a radiation disaster.[ema.europa.eu]
  • Nevertheless, the parts of the body that are not being x-rayed will be shielded with a lead apron to prevent unnecessary exposure. The technician, meanwhile, will leave the room when taking the image.[medicalnewstoday.com]

References

Article

  1. Dörr H, Meineke V. Acute radiation syndrome caused by accidental radiation exposure - therapeutic principles. BMC Med. 2011;9:126.
  2. Dainiak N, Waselenko JK, Armitage JO, MacVittie TJ, Farese AM. The hematologist and radiation casualties. Hematology Am Soc Hematol Educ Program. 2003;473-496.
  3. Drouet M, Hérodin F. Mitigating Radiation-induced Toxicity: An Overview of New Approaches Developed at the French Military Biomedical Research Institute. Health Phys. Jun 2014;106(6):682–688.
  4. Dainiak N. Rationale and recommendations for treatment of radiation injury with cytokines. Health Phys. Jun 2010;98(6):838–842.
  5. López M, Martín M. Medical management of the acute radiation syndrome. Rep Pract Oncol Radiother. Jul 2011;16(4): 138–146.
  6. Rezvani M, Hopewell JW, Wilkinson JH. Time and dose related changes in the thickness of skin in the pig after irradiation with single doses of thallium-170 beta particles. Radiat Res. 2000;153:104.
  7. Gourmelon P, Benderitter M, Bertho JM, et al. European consensus on the medical management of acute radiation syndrome and analysis of the radiation accidents in Belgium and Senegal. Health Physics. Jun 2014;106(6):682–688.
  8. Gorin NC, Fliedner TM, Gourmelon P. Consensus conference on European preparedness for haematological and other medical management of mass radiation accidents. Ann Hematol. 2006;85:671–679.
  9. Ainsbury EA, Bakhanova E, Barquinero JF, et al. Review of retrospective dosimetry techniques for external ionising radiation exposures.Radiat Prot Dosimetry. Nov 2011;147(4):573-92.
  10. Rea ME, Gougelet RM, Nicolalde RJ. Proposed triage categories for large-scale radiation incidents using high-accuracy biodosimetry methods. Health Phys. Feb 2010;98(2):136–144.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-07-11 20:38