Radiation sickness, acute
Disease/Syndrome
Radiation sickness, acute
Acute/Chronic
Acute-Severe (life-threatening)
Synonyms
Acute radiation syndrome
Comments
DIAGNOSIS: We all receive background radiation that includes radon, cosmic radiation, radioactive potassium in the body, and medical x-rays. The average dose of background radiation per person is 360 mrem/year. A radiation dose of less than 10,000 mrem (10 rads) causes no acute effects. After a dose of 100-200 rads, nausea and vomiting are possible three or more hours after the incident, and mild bone marrow depression can be detected. After a dose of 200 rads and higher, patients develop nausea/vomiting, and medical evaluation and treatment are required. The dose of radiation can be estimated from the onset of vomiting post incident:
More than 2 hours after = less than 200 rads;
1-2 hours = 200-400 rads;
Less than 1 hour = 400-600 rads;
10-30 minutes = 600-800 rads;
Less than 10 minutes = greater than 800 rads;
The severity of the radiation sickness can also be predicted by the slope of the absolute lymphocyte count. At 48 hours post incident: >1500 = normal; 1000-1500 = survival without treatment; 500-1000 = survival with treatment; and <500 = very severe or lethal exposure. The fatal dose to 50% of patients within 60 days is 400 rads. FINDINGS: The three syndromes of radiation sickness after high-dose, whole-body external irradiation are: 1.) The cerebral syndrome--greater than 1000 rads causes death in a few hours or days; 2.) The GI syndrome--greater than 400 rads causes intractable vomiting and diarrhea with few survivors; and 3.) The hematopoietic syndrome--greater than 200 rads causes bone marrow damage and resulting infections at 2-4 weeks and bleeding at 3-6 weeks. Patients with the hematopoietic syndrome have a mild prodromal phase beginning after 6-12 hours and lasting 24-36 hours. Symptoms in the prodromal phase may include anorexia, nausea, vomiting, diarrhea, low-grade fever, conjunctivitis, erythema, fatigue, and leukocytosis. Next is the latent phase, an asymptomatic period lasting more than a week prior to the manifest phase when bone marrow production drops to a critical level. The manifest phase is followed by recovery or death. Patients often have radiation burns to the skin that are similar to thermal burns except for delayed onset. Swollen and tender salivary glands (parotid and submandibular) are often detected in the first several hours after exposure. TREATMENT: Irradiated victims are not radioactive. First stabilize life-threatening conditions. Universal precautions are protective for healthcare workers. If externally contaminated, admit to a controlled area and remove clothing. If possibly internally contaminated, identify contaminant. Treatment of internal contamination is radionuclide-specific. It is more effective when administered early. Contact REAC/TS for assistance: 865-576-1005. [REAC/TS; CDC Radiological Terrorism; Emergency Department Management of Radiation Casualties; Waselenko]
Latency/Incubation
Prodromal symptoms develop within minutes to 1 hour (cerebral syndrome); 2-12 hours (GI syndrome), and 6-12 hours (hematopoietic syndrome);
Diagnostic
Clinical; Lymphocyte and platelet counts; Serum amylase;
Symptoms/Findings
Symptoms/Findings associated with this disease:
Agents
Hazardous agents that cause the occupational disease: