Acute radiation syndrome: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
===Clinical Syndromes<ref name="SNSRWG" /><ref name="Donnelly" />=== | |||
*Gastrointestinal (GI) Syndrome | ====Bone Marrow Syndrome==== | ||
*Cardiovascular (CV)/Central Nervous System (CNS) Syndrome | *Clinical syndrome seen at doses >100-200 rad (1-2 Gy) | ||
**Smaller doses cause clinically insignificant pancytopenia) | |||
*Lymphocytes depleted first, then granulocytes, platelets, and RBCs | |||
**Lymphocyte depletion is predictable based on dose | |||
*Death usually 2/2 infection or hemorrhage and poor healing | |||
**Doses >350 rad fatal within several months if untreated | |||
====Gastrointestinal (GI) Syndrome==== | |||
*Syndrome occurs at 600-1000 rad (6-10 Gy) | |||
*Characterized by abdominal pain, nausea, vomiting, diarrhea, ileus | |||
*Death occurs within weeks 2/2 multiorgan failure and sepsis if untreated | |||
====Cardiovascular (CV)/Central Nervous System (CNS) Syndrome==== | |||
*Syndrome occurs at >1000-2000 rad (10-20 Gy) | |||
**At this dose, vomiting is suppressed | |||
**Characterized by ALOC, dizziness, papilledema, ↓ DTRs, ataxia, coma | |||
*Doses >3500 rad (35 Gy) damage large blood vessels → cardiovascular failure, cerebral edema | |||
*Doses >5000 rad (50 Gy) cause death within 48 hours | |||
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===Clinical Course<ref name="SNSRWG" /><ref name="Donnelly">Donnelly EH1, Nemhauser JB, Smith JM, et al. Acute radiation syndrome: assessment and management. South Med J. 2010 Jun;103(6):541-6.</ref>=== | ===Clinical Course<ref name="SNSRWG" /><ref name="Donnelly">Donnelly EH1, Nemhauser JB, Smith JM, et al. Acute radiation syndrome: assessment and management. South Med J. 2010 Jun;103(6):541-6.</ref>=== | ||
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*Characterized by nausea and vomiting | *Characterized by nausea and vomiting | ||
**Other symptoms include: malaise, fever, conjunctivitis | **Other symptoms include: malaise, fever, conjunctivitis | ||
**Doses over 1000 rad (10 Gy), vomiting is not seen in early sx | |||
*Occurs within 48h-6d of exposure (at higher doses, can begin within minutes) | *Occurs within 48h-6d of exposure (at higher doses, can begin within minutes) | ||
*Lasts up to 2 days | *Lasts up to 2 days | ||
Revision as of 07:12, 13 July 2015
Background
- Also called radiation poisoning, radiation toxicity, or radiation sickness.
- Acute illness caused by exposure to high doses (at least 1 Gy)[1] of ionizing radiation over a short period of time.
- 1 Gray (Gy) = 100 rads
- Generally requires exposure of whole body (or most of the body)
- Fast-replicating cell lines most affected - GI, lymphohematopoietic, spermatocytes
Clinical Features
Clinical Syndromes[1][2]
Bone Marrow Syndrome
- Clinical syndrome seen at doses >100-200 rad (1-2 Gy)
- Smaller doses cause clinically insignificant pancytopenia)
- Lymphocytes depleted first, then granulocytes, platelets, and RBCs
- Lymphocyte depletion is predictable based on dose
- Death usually 2/2 infection or hemorrhage and poor healing
- Doses >350 rad fatal within several months if untreated
Gastrointestinal (GI) Syndrome
- Syndrome occurs at 600-1000 rad (6-10 Gy)
- Characterized by abdominal pain, nausea, vomiting, diarrhea, ileus
- Death occurs within weeks 2/2 multiorgan failure and sepsis if untreated
Cardiovascular (CV)/Central Nervous System (CNS) Syndrome
- Syndrome occurs at >1000-2000 rad (10-20 Gy)
- At this dose, vomiting is suppressed
- Characterized by ALOC, dizziness, papilledema, ↓ DTRs, ataxia, coma
- Doses >3500 rad (35 Gy) damage large blood vessels → cardiovascular failure, cerebral edema
- Doses >5000 rad (50 Gy) cause death within 48 hours
Clinical Course[1][2]
- Each ARS syndrome typically progresses through 4 stages of disease
Prodromal Stage
- Characterized by nausea and vomiting
- Other symptoms include: malaise, fever, conjunctivitis
- Doses over 1000 rad (10 Gy), vomiting is not seen in early sx
- Occurs within 48h-6d of exposure (at higher doses, can begin within minutes)
- Lasts up to 2 days
Latent Stage
- Short period of symptom improvement
- Lasts several days to 1 month
Manifest Illness Stage
- Manifestation of symptoms of clinical syndromes
- Severity based on, among other things:
- Overall dose
- Irradiated body volume
- Comorbidities and overall health status
- Age
- Characterized by significant immunosuppression
- Lasts for days to months
Recovery or Death
- If pt survives manifest illness stage, recovery is slow (weeks to years)
- If lethal dose received, death can occur within days (very high, rapid doses) or may be delayed up to several months
Differential Diagnosis
Nausea and vomiting
Critical
Emergent
- Acute radiation syndrome
- Acute gastric dilation
- Adrenal insufficiency
- Appendicitis
- Bowel obstruction/ileus
- Carbon monoxide poisoning
- Cholecystitis
- CNS tumor
- Electrolyte abnormalities
- Elevated ICP
- Gastric outlet obstruction, gastric volvulus
- Hyperemesis gravidarum
- Medication related
- Pancreatitis
- Peritonitis
- Ruptured viscus
- Testicular torsion/ovarian torsion
Nonemergent
- Acute gastroenteritis
- Biliary colic
- Cannabinoid hyperemesis syndrome
- Chemotherapy
- Cyclic vomiting syndrome
- ETOH
- Gastritis
- Gastroenteritis
- Gastroparesis
- Hepatitis
- Labyrinthitis
- Migraine
- Medication related
- Motion sickness
- Narcotic withdrawal
- Thyroid
- Pregnancy
- Peptic ulcer disease
- Renal colic
- UTI
Diagnosis
- Clinical diagnosis, based on history and physical.
Treatment
Disposition
- Admit
See Also
References
- ↑ 1.0 1.1 1.2 Waselenko JK, MacVittie TJ, Blakely WF, et al. Medical management of the acute radiation syndrome: recommendations of the Strategic National Stockpile Radiation Working Group. Ann Intern Med. 2004 Jun 15;140(12):1037-51.
- ↑ 2.0 2.1 Donnelly EH1, Nemhauser JB, Smith JM, et al. Acute radiation syndrome: assessment and management. South Med J. 2010 Jun;103(6):541-6.