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What is radiation sickness?
Radiation sickness, also known as acute radiation syndrome (ARS), is a life-threatening condition that results from prolonged or significant exposure to ionizing radiation to your whole body or a large portion of your body. It can lead to death within hours or several months after exposure.
Radiation sickness is generally associated with acute (sudden and severe) exposure and has a set of symptoms that appear in a predictable order. Chronic radiation exposure is usually associated with prolonged medical problems, such as cancer and premature aging. These complications may happen over a long period of time.
The severity of radiation sickness depends on the dose and the length of time over which you’re exposed. Exposure to a high, single dose over minutes to hours is more damaging than several smaller doses given over weeks or months to a small area of your body (such as with cancer therapy).
What is ionizing radiation?
Ionizing radiation is a form of energy that removes electrons from atoms and molecules of substances that include air, water and living tissue. You can’t see ionizing radiation.
Medical diagnostic procedures rarely have radiation doses high enough to cause radiation injury. Radiation sickness happens after significant exposure to radiation, such as from exposure from a nuclear power plant accident or excessive radiation for medical treatments.
Everyone is exposed to low levels of ionizing radiation every day — usually from natural sources, such as space, earth and building materials. There are manmade sources of ionizing radiation, too. These most commonly include medical imaging tests or treatments such as X-rays, CT (computed tomography) scans and radiation therapy.
Ionizing radiation exposure that results in radiation sickness is often measured in a unit called the gray (Gy). It’s the amount of radiation that your body absorbs.
The mildest (though still harmful) form of radiation sickness happens at 1 to 6 Gy. Death is usually guaranteed at exposure of 10 Gy or more.
How common is radiation sickness?
Radiological or nuclear emergencies that result in radiation sickness are rare, but they can involve significant numbers of people. For example, after the Chornobyl nuclear power plant disaster in 1986, approximately 6,000 children developed thyroid cancer.
The most significant radiation exposure to a population occurred following the detonation of two atomic bombs over Japan in August 1945. It caused about 110,000 deaths from the immediate blast. Around an additional 1,000 people died over the course of 70 years after the detonation due to radiation-induced cancer.
How do high doses of radiation affect my body?
Large doses of ionizing radiation cause cell death. Lower doses can interfere with cellular repair systems, cell growth and cell division.
The cells that are especially sensitive to high doses of radiation include cells in your bone marrow, gastrointestinal tract and skin. You typically have symptoms related to damage of these tissues first after significant exposure.
Symptoms and Causes
What are the symptoms of radiation sickness?
The severity of symptoms depends on:
- The amount of radiation exposure.
- How long you were exposed.
- If all or a certain part of your body was exposed.
Symptoms may begin right after exposure or over the next few days, weeks or months.
After acute exposure to a high dose of radiation, several distinct syndromes may occur, including:
- Cerebrovascular syndrome (affecting blood flow to your brain).
- Gastrointestinal (GI) syndrome (affecting the passageway of your digestive system).
- Hematopoietic syndrome (affecting the formation of all types of blood cells).
Each of these syndromes has three different phases, including:
- Prodromal phase: This phase starts minutes to two days after exposure. You might feel drowsy and weak and have nausea, vomiting or diarrhea.
- Latent asymptomatic phase: This phase begins hours to 21 days after exposure. You don’t have any symptoms during this phase.
- Overt systemic illness phase: This phase begins hours to fewer than 60 days after exposure. The symptoms depend on which main organ system of the above syndromes is affected.
Symptoms of cerebrovascular syndrome
Cerebrovascular syndrome is always fatal. It happens after extremely high whole-body doses of radiation (more than 30 Gy).
The prodromal phase develops within minutes to one hour after exposure. The latent phase is nonexistent or very brief. In the overt systemic illness phase, symptoms include:
- Cerebral edema (when fluid builds up around your brain, causing an increase in pressure).
Death occurs within hours to one to two days.
Symptoms of gastrointestinal (GI) syndrome
GI syndrome happens after whole-body radiation doses of about 6 to 30 Gy.
Prodromal symptoms develop within about one hour after exposure and resolve within two days. The latent phase lasts four to five days.
Symptoms of the overt systemic illness phase include:
- Severe nausea, vomiting and diarrhea.
- Severe dehydration and electrolyte imbalances.
- Lack of plasma in your blood, which is mainly water.
- Cardiovascular collapse (the rapid or sudden development of circulatory failure).
- Necrosis (death) of your intestines, which could lead to sepsis.
Death is common. Survivors also have the hematopoietic syndrome.
Symptoms of hematopoietic syndrome
Hematopoietic syndrome happens after whole-body radiation doses of about 1 to 6 Gy and involves generalized pancytopenia. This is a deficiency of all three cellular components of your blood:
The prodromal phase is mild and may begin one to six hours after exposure, lasting 24 to 48 hours. The latent asymptomatic phase lasts about four weeks.
Symptoms of the overt phase include:
- Risk of various infections due to neutropenia and decreased antibody production.
- Petechiae and mucosal bleeding, which may last for months.
- Anemia, which develops slowly.
Survivors have an increased likelihood of radiation-induced cancer, including leukemia and thyroid cancer.
What causes radiation sickness?
Radiation sickness (acute radiation syndrome) can result from direct exposure or contamination by radioactive materials.
A nuclear blast, radiation accidents and fallout from nuclear weapons testing can result in direct exposure. Contamination can result from consuming nuclear-contaminated food and water and skin contact with the nuclear material.
Is radiation sickness contagious?
If someone who has been exposed to a high dose of radiation is decontaminated — their clothes are removed and their body is washed — they’re not “contagious.” You’re not at risk of radiation exposure from them because the radiation is internalized.
If someone who has been exposed to a high dose of radiation isn’t decontaminated, and you’re near them, you’re at risk for radiation exposure. First responders to nuclear emergencies, for example, are at higher risk of exposure from other people.
Diagnosis and Tests
How is radiation sickness diagnosed?
Healthcare providers diagnose radiation sickness using the following:
- History of radiation exposure.
- Symptoms and signs.
- Laboratory testing.
The onset, timeframe and severity of symptoms can help providers determine the radiation dose and predict the symptoms and complications.
After acute radiation exposure, providers order complete blood count (CBC) tests 24, 48 and 72 hours after exposure to estimate the initial radiation dose and prognosis. Providers may order other blood tests.
When providers suspect radioactive contamination, they test your entire body with a tool called a Geiger-Muller counter to detect and measure ionizing radiation. To detect possible internal contamination, a provider will wipe your ears, mouth and wounds with swabs that they then test with the counter. They may also test your pee and poop for radioactivity.
Management and Treatment
What is the treatment for radiation sickness?
The treatment for radiation sickness varies based on its severity. As significant exposure usually results from radiological or nuclear emergencies, healthcare providers and first responders prioritize care based on the severity of symptoms and injuries.
Some general treatment strategies include:
- Decontamination (removing clothing and thoroughly washing your body) to protect others from further exposure.
- Surgical procedures for those who have life-threatening injuries.
- Supportive care, such as fluid and electrolyte management; pain control for burns and other injuries; and early treatment of any signs of infection with antibiotics.
- Prevention of thyroid cancer. Providers typically recommend that all children and people who are pregnant who were exposed take potassium iodide to protect their thyroid from the uptake of radioactive iodine.
- Management of psychological trauma with psychotherapy (talk therapy) and/or medication.
How can I prevent radiation sickness?
There’s nothing you can do to prevent emergencies that lead to significant radiation exposure and radiation sickness. But there are steps you can take if a nuclear emergency happens, including:
- Leave (or don’t enter) the area where exposure occurred.
- Remove contaminated clothing as soon as possible and store it in a sealed container. Wash your body thoroughly with soap and water.
- Seek emergency medical treatment as soon as possible.
Outlook / Prognosis
What is the prognosis of radiation sickness?
The prognosis (outlook) of radiation sickness depends on several factors, including:
- How much radiation your body absorbed.
- How much of your body was affected.
- If you were able to get immediate medical care.
Radiation sickness is often fatal. The time to death decreases as the dose of radiation decreases.
Cerebrovascular syndrome is always fatal within hours to days after exposure.
Death usually occurs within two days to several weeks for those who have gastrointestinal syndrome.
For people with hematopoietic syndrome, death may happen within four to eight weeks due to an infection or a significant hemorrhage (bleeding).
People who were exposed to whole-body doses of less than 2 Gy usually fully recover within one month. But long-term complications, such as cancer, may occur.
A note from Cleveland Clinic
Radiation sickness is a life-threatening condition that happens after significant radiation exposure. While there’s nothing you can do to prevent it, there are steps you can take if you’ve been exposed after a radiological or nuclear emergency. If possible, decontaminate yourself by removing your clothes and washing your body. Then, get medical care as soon as possible.
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