Radiation Sickness Disease

DESCRIPTION

Any somatic or genetic disruption of function or form caused by electromagnetic waves or accelerated atomic particles

Acute radiation sickness: Symptoms occurring within 24 hours of exposure
Chronic radiation syndrome: Symptoms occurring greater than 24 hours after exposure, and generally over an extended time
Radiation measures:
- 1 rad is the absorption of 100 ergs of energy by 1 gram of tissue
- 100 rads = 1 gray (Gy)
- The REM (Radiation Equivalent Man) unit was developed because different tissues have different sensitivities to radiation. 1 REM is radiation dose in rads multiplied by a relative biologic effectiveness factor for the tissue involved. 100 REM = 1 sievert (Sv)
Radiation includes:
- Electromagnetic emissions: Energy (and hence penetration) is inversely proportional to wavelength, e.g., x-rays, gamma rays
- Particles. Alpha particles are the nuclei of helium atoms and beta particles are electrons. Both have low penetrance externally but are dangerous if ingested. Neutrons are damaging and penetrate well. Includes electrons, protons, alpha particles, neutron, negative pi-mesons, and heavy charged ions.
System(s) affected: Reproductive, Renal/Urologic, Cardiovascular, Nervous, Gastrointestinal, Skin/Exocrine, Hemic/Lymphatic/Immunologic, Pulmonary, Musculoskeletal
Genetics: Females tolerate better than males. The exception is pregnant females with risk of fetal injury at low dose.
Incidence/Prevalence in USA:
- Most acute radiation injury is related to accidents or radiation therapy
- 400,000 patients receive radiation therapy yearly for malignancies
- Accidents are sporadic and usually involve small numbers of individuals
- Historically:
  - 120,000 individuals developed acute radiation syndrome in Japan as a result of nuclear explosions
  - 7,266 natives of the Marshall Islands were exposed to radiation due to errors in judging winds after a nuclear test in the South Pacific
  - Chernobyl accident in Russia in 1986 where an estimated 50,000 individuals received at least 0.5 Sv of exposure
Predominant age: N/A
Predominant sex: N/A

SIGNS AND SYMPTOMS

Acute radiation exposure is divided into several syndromes:
- Less than 200 rads: No disease. There may be some nausea more than 3 hours after the event. Nausea is not a reliable sign of exposure since most people involved in an accident of this type will complain of some nausea when questioned.
- 200-1000 rads = hematopoietic syndrome. Acute nausea and vomiting within 3 hours. Acute granulocyte elevation, then lymphopenia, then thrombocytopenia and neutropenia, then anemia. Peak lowering of platelets and granulocytes at 3 weeks (resolving in 12 weeks). Lymphopenia may last years. Survivors may get lung or kidney changes months after. Death rate 0-80% depending on dose received and treatment. Ld 50 for humans is 650 rads.
- 1000-5000 rads = gastrointestinal syndrome. Nausea and vomiting 30-60 minutes postexposure. Loss of the villus structure of small bowel. Severe GI bleeding, diarrhea and abdominal pain develop in 3 days and precede the hematopoietic syndrome. Death due to blood loss or gram negative sepsis. Survivors usually die late of bone marrow suppression. Death rate 80-100%.
- Over 5000 rads = neurovascular syndrome or "Spock syndrome". After a 15-30 minute asymptomatic period; tremors, ataxia, vomiting, hypotension, seizures and death. Death rate 100%.

CAUSES

Nuclear weapons
Industrial accidents
Nuclear power accidents
Radiation therapy

RISK FACTORS

Young patients more susceptible than old
Men more sensitive than women
Debilitated more susceptible than healthy

LABORATORY

Lymphocyte count at 48 hours post event
- Over 1500 = trivial or no exposure
- Over 1000 = survival without treatment
- 500-1000 = survival with treatment
- 100-400 = death without bone marrow transplant
- Under 100 = certain death

Drugs that may alter lab results: Chemotherapeutic agents cause bone marrow suppression identical to radiation exposure
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Hypocellular marrow with the hematopoietic syndrome
The GI syndrome with loss of villus margin and sloughing of villus structure
Late cases with fibrosis of lung, liver and kidney tissues
Loss of hair indicates exposure of 350 rads and is complete at 700 rads

SPECIAL TESTS

Total body dosimetry may suggest dose of compound ingested. Most radioisotopes are not excreted well.

IMAGING

N/A

DIAGNOSTIC PROCEDURES

N/A

APPROPRIATE HEALTH CARE

Inpatient

GENERAL MEASURES

Step 1 is decontamination to reduce external radiation and collateral exposure
IV fluids, antinauseants and bedrest
Platelet, RBC and WBC transfusion if needed
Antibiotics for sepsis and neutropenia
Treatment of collateral injuries such as burns and lacerations only after decontamination

SURGICAL MEASURES

Debridement of all wounds to decontaminate
All surgery within two days before loss of white cell and platelet function
Bone marrow transplant for severe exposure

ACTIVITY

Isolation techniques for immune system injury

DIET

As tolerated. Hyperalimentation for severe GI syndromes.

PATIENT EDUCATION

Recommend genetic counseling and screening to persons who have been exposed to significant amounts of radiation

PREVENTION/AVOIDANCE

Follow safety procedures

POSSIBLE COMPLICATIONS

Long-term fibrosis of kidneys, liver and lung. Occur within 6 months of acute exposure and with as little as 300 rads of exposure.
Radiation exposure can induce malignancies
Increased long-term risk of leukemia (acute lymphocytic or chronic myelogenous)
Multiple myeloma and cancers of the breast, esophagus, stomach, colon, lung, ovary, bladder, thyroid
Sterility

EXPECTED COURSE AND PROGNOSIS

Patients surviving 12 weeks have excellent prognosis but should be monitored for long-term complications
Hair lost usually returns within 2 months

ASSOCIATED CONDITIONS

N/A

AGE-RELATED FACTORS

Pediatric: More sensitive to injury
Geriatric: Less sensitive to injury
Others: N/A

PREGNANCY

Injury to fetus likely

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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