Acute Radiation Syndrome

Definition

Acute radiation syndrome (ARS) which is also referred to as radiation sickness is a rare type of illness that causes certain damage to the body by a large dosage of penetrating radiation in a short span of time. Common radiation exposures to low dosage of radiation like CT scans or X-rays do not cause ACS. This disease is frequently serious and life-threatening.

Examples of individuals who had suffered from acute radiation syndrome are the ones who survived the atomic bombings of Hiroshima and Nagasaki during World War II, the firefighters who first made a response after the Chernobyl Nuclear Power Plant event back in 1986, and those who accidentally got exposed to sterilization irradiators.

Causes

Radiation itself is the energy freed from atoms, either through a small particle of matter or a wave. Acute radiation syndrome is a result from a high dosage of radiation, like the ones received in an industrial accident.

The following predisposing factors which may also lead to ARS are:

• An explosion of a tiny radioactive device
• An unfortunate incident at a nuclear industrial facilities
• A certain attack in a nuclear industrial facility
• An explosion of a conventional device that scatters radioactive material

Acute radiation syndrome can occur when high-dose of radiation causes some damage or destroys a number of cells in the body. The most prone areas of the body to high-dose radiation are those cells in the lining of the intestinal tract which involves the blood cell-producing cells of the bone marrow and the stomach.

The following conditions are usually noted in a patient known to have Acute Radiation Syndrome:

• The dose is typically delivered in a short period of time
• The radiation should be penetrating such as reaching certain internal organs
• A significant part or the entire body must have sustained the dose
• The dosage of the radiation must be large
• The radiation source should be external or outside of the person’s body

Symptoms of Acute Radiation Syndrome

Radiation effects resulting from ARS leads to a cellular degradation from the DNA damage and certain molecular structures in various tissues or cells of the body. This type of destruction specifically affects the capacity of the cells to normally divide, in turn resulting to the symptoms of the condition.

These symptoms can start within hours, and could last for a couple of months. The type and onset and signs of ARS vary on the radiation exposure. Generally, the greater the radiation exposure is, the more severe the symptoms will be.

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
• Fatigue
• Hair loss
• Dehydration
• Low blood pressure
• Disorientation

Stages

The four stages of Acute Radiation Syndrome are:

• Prodromal stage (N-V-D stage) – The typical symptoms of this stage include vomiting, nausea, diarrhea, as well as anorexia, which appear from minutes to days after exposure. The symptoms are episodic.
• Latent stage – The patient feels and looks healthy for a couple of hours or possibly up to several weeks.
• Manifest illness stage – The symptoms vary on the specific ARS syndrome and could last for hours or months.
• Recovery or death – Majority of the patients who do not get better will die within a few months of exposure. The process of recovery keeps on going from several weeks up to two years.

Treatment

The treatments for acute radiation syndrome aim on the prevention of further contamination of the radiation, treat fatal injuries, reduce symptoms, and control pain.

Treatment options may include:

Decontamination – Getting rid of external radioactive particles as much as possible and preventing further distribution of radioactive materials.

Granulocyte colony-stimulating factor – It is a protein that promotes white blood cell growths and could counter ARS on the bone marrow.

Internal contamination treatment – These may include potassium iodide, Prussian blue, and diethylenetriamine pentaacetic acid depending on the specific type of radiation.

Supportive treatment – A patient may be given additional interventions and medications to treat certain symptoms.

End-of-life care – For patients who have absorbed high-dose radiations, the chance of recovery is little and could die within a few days or weeks. Individuals in this stage will receive some medications to manage diarrhea, nausea, vomiting, and pain.

References

1. http://www.mayoclinic.org/diseases-conditions/radiation-sickness/basics/definition/con-20022901
2. http://emergency.cdc.gov/radiation/arsphysicianfactsheet.asp#table1
3. https://www.nlm.nih.gov/medlineplus/ency/article/000026.htm
4. Christensen DM, Iddins CJ, Sugarman SL (February 2014). “Ionizing radiation injuries and illnesses”. Emerg Med Clin North Am 32 (1): 245–65.
5. Donnelly EH, Nemhauser JB, Smith JM; et al. (June 2010). “Acute radiation syndrome: assessment and management”. South. Med. J. 103 (6): 541–6.
6. Xiao M, Whitnall MH; Whitnall (January 2009). “Pharmacological countermeasures for the acute radiation syndrome”. Curr Mol Pharmacol 2 (1): 122–33.