RADIATION SICKNESS

Radiation sickness, formally called acute radiation syndrome, is caused by intense radiation penetrating the body and harming organs. It takes much higher doses than those used in medical X-rays or scans to cause this illness.

Causes

Radiation sickness results from exposure to a substantial dose of radiation, which is the energy emitted from atoms in the form of either waves or minute particles of matter.

The condition occurs when high-energy radiation disrupts or eradicates specific cells within the body. The bone marrow cells and the lining of the intestinal tract are particularly vulnerable to the effects of high-energy radiation, making them the areas most susceptible to damage.

Historical Cases and Modern Prevention

The condition gained its name after the atomic bombs used in World War II. Though the exact number of deaths from radiation sickness in those bombings is unknown, estimates suggest hundreds to thousands. Since then, occurrences have been rare, with about 50 deaths reported. This includes workers at the Chernobyl nuclear accident and some scientists or technicians during the Cold War. More recently, an accident in Japan involving nuclear fuel caused radiation sickness in three workers, two of whom died. Thankfully, no cases were reported after the Fukushima nuclear accident in 2011.

Understanding Radiation Levels

Radiation exposure is quantified using the sievert (Sv), an international unit of measurement. Symptoms of radiation sickness become apparent when exposure levels surpass 500 millisieverts (mSv), equivalent to half a sievert. Exposure exceeding 4 to 5 Sv is highly likely to be fatal.

During the Chernobyl incident, workers affected by radiation sickness received doses ranging from 700 mSv to 13 Sv, underscoring the severity of their exposure.

Natural and Man-Made Radiation Sources

Radiation is ubiquitous in our environment, stemming from natural sources like:

the air
water
materials such as brick or granite.

On average, individuals are exposed to around 3 mSv of radiation annually from these natural sources.

Man-made sources

Man-made sources, including X-rays, contribute an additional 3 mSv to yearly exposure. For instance, a CT (computerized tomography) scan, which utilizes multiple X-rays from various angles, typically delivers around 10 mSv of radiation.

To mitigate risks, regulations in the nuclear industry limit annual exposure for workers to 50 mSv, emphasizing the importance of stringent safety measures in environments where radiation is present.

Risk Factors

The risk of radiation sickness is heightened by exposure to sources emitting high doses of radiation. These sources can include:

Accidents occurring at nuclear industrial facilities.
Deliberate attacks targeting nuclear industrial facilities.
Detonation of a small radioactive device.
Deployment of an explosive device dispersing radioactive material, known as a dirty bomb.
Detonation of a nuclear weapon.

Symptoms

The severity of symptoms associated with radiation sickness hinges on the extent of radiation absorption, influenced by factors like the intensity of the radiation, duration of exposure, and distance from the radiation source.

The type of exposure, whether it’s total or partial body, also plays a role in symptom severity, as does the sensitivity of the affected tissues. Tissues like the gastrointestinal system and bone marrow are particularly sensitive to radiation.

Typically, the initial symptoms of radiation sickness are treatable and often include nausea and vomiting. The time elapsed between exposure and the onset of these symptoms indicates the level of radiation absorption.

Following the initial symptoms, there may be a brief period without noticeable illness, followed by the emergence of more severe symptoms. The timeframe for symptom onset varies depending on the level of exposure. Mild exposure may result in symptoms appearing hours to weeks later, while high exposure can lead to symptoms developing within minutes to days.

Potential symptoms encompass:

Nausea and vomiting
Diarrhea
Headache
Fever
Dizziness and disorientation
Weakness and fatigue
Hair loss
Bloody vomit and stools due to internal bleeding
Infections
Low blood pressure

In the event of an accident or deliberate attack causing radiation exposure, it’s essential to stay informed by following emergency instructions broadcast via radio, television, or online platforms. If you suspect you’ve been overexposed to radiation, seek immediate medical attention to ensure prompt treatment and management of symptoms.

Body parts affected

Radiation primarily targets vital bodily systems, including:

the stomach,
intestines,
blood vessels,
and bone marrow, responsible for producing blood cells.

Damage to the bone marrow leads to a reduction in disease-fighting white blood cells, rendering individuals vulnerable to infections and internal bleeding, which are the primary causes of fatalities associated with radiation sickness.

Diagnosis

When someone has been exposed to a high dose of radiation, whether from an accident or attack, medical professionals take several steps to assess the absorbed radiation dose. This information is crucial for determining the severity of the illness, selecting appropriate treatments, and assessing the likelihood of survival.

Key information used to determine the absorbed dose includes:

Known Exposure: Details regarding the distance from the radiation source and the duration of exposure help estimate the severity of radiation sickness.
Symptoms, Especially Vomiting: The time elapsed between radiation exposure and the onset of vomiting is a useful indicator of absorbed radiation dose. A shorter interval before vomiting indicates a higher dose. Other symptoms and their severity and timing also aid in assessing the absorbed dose.
Blood Tests: Regular blood tests conducted over several days enable medical professionals to monitor changes such as decreases in disease-fighting white blood cells and abnormal alterations in the DNA of blood cells. These changes reflect the extent of bone marrow damage, which correlates with the absorbed dose level.
Dosimeter: A dosimeter device can measure the absorbed radiation dose, provided it was exposed to the same radiation event as the affected person.
Survey Meter: Devices like Geiger counters can be used to assess individuals and determine the locations of radioactive particles within the body.
Type of Radiation: As part of the broader emergency response to a radioactive incident, identifying the type of radiation exposure informs treatment decisions for individuals with radiation sickness.

By gathering and analyzing this information, medical personnel can better understand the extent of radiation exposure, tailor treatments accordingly, and improve outcomes for those affected by radiation sickness.

Treatment

The treatment approach for radiation sickness aims to achieve several goals: preventing further radioactive contamination, addressing life-threatening injuries such as burns and trauma, alleviating symptoms, and managing pain.

Decontamination: This involves removing external radioactive particles. Most of these particles can be eliminated by removing contaminated clothing and shoes, which accounts for about 90% of external contamination. Gentle washing with water and soap further removes radiation particles from the skin. Decontamination not only prevents the spread of radioactive materials but also reduces the risk of internal contamination through inhalation, ingestion, or open wounds.
Treatment for damaged bone marrow: A protein known as granulocyte colony-stimulating factor can stimulate the growth of white blood cells, countering the effects of radiation on bone marrow. Medications containing this protein, such as filgrastim (Neupogen), sargramostim (Leukine), and pegfilgrastim (Neulasta), may boost white blood cell production and help prevent infections. In severe cases of bone marrow damage, transfusions of red blood cells or blood platelets may be necessary.
Treatment for internal contamination: Specific treatments may reduce damage to internal organs caused by radioactive particles. Potassium iodide, a nonradioactive form of iodine, can prevent the absorption of radioactive iodine by saturating the thyroid with non-radioactive iodine. Prussian blue (Radiogardase) binds to radioactive cesium and thallium particles, facilitating their elimination from the body. Diethylenetriamine pentaacetic acid (DTPA) binds to radioactive metals like plutonium, americium, and curium, aiding in their excretion through urine.
Supportive treatment: Additional medications and interventions may be administered to manage various symptoms and complications associated with radiation sickness, including bacterial infections, headache, fever, diarrhea, nausea, vomiting, dehydration, burns, and sores or ulcers.

Recovery Timeline and Long-Term Risks

Recovery from radiation sickness is a prolonged process, often spanning up to two years. However, even after recovery, individuals remain susceptible to various health complications, notably an increased risk of developing cancer. Therefore, ongoing monitoring and preventive measures are imperative for maintaining overall well-being post-recovery.

Preventions

In the event of a radiation emergency, it’s crucial to follow guidance provided by local, state, and federal authorities. Depending on the circumstances, you may be instructed to either shelter in place or evacuate your area.

Sheltering in place involves taking the following precautions:

Close and secure all doors and windows.
Turn off fans, air conditioners, and heating units that draw air from outside.
Shut fireplace dampers.
Bring pets indoors.
Move to an inner room or basement.
Stay informed by listening to your local emergency response network or news channels.
Remain in place for at least 24 hours to minimize exposure.

If evacuation is advised, it’s essential to remain calm and follow the instructions provided by local authorities. When evacuating, move quickly and orderly, taking only essential supplies, including:

Flashlight.
Portable radio.
Batteries.
First-aid kit.
Necessary medications.
Sealed food, such as canned goods, and bottled water.
Manual can opener.
Cash and credit cards.
Extra clothing.

It’s important to note that most emergency vehicles and shelters may not accommodate pets. If you decide to bring your pets, do so only if you’re traveling in your own vehicle and have alternative arrangements for sheltering them.

Complications

Experiencing radiation sickness can lead to various mental health challenges, both in the short and long term. These can include feelings of grief, fear, and anxiety related to:

The traumatic experience of being involved in a radioactive accident or attack.
Coping with the loss of friends or family members who may not have survived the incident.
Navigating the uncertainty surrounding a mysterious and potentially life-threatening illness.
Concerns about the heightened risk of developing cancer in the future due to radiation exposure.

Sources

Photo credit: dr. raos hospitals
Garau, M. Reports of Practical Oncology and Radiotherapy, July 2011.
U.S. Atomic Energy Commission: “Medical Effects of Atomic Bombs.”
U.S. Centers for Disease Control and Prevention.
U.S. Nuclear Regulatory Commission.
Radiation Effects Research Commission: “Frequently Asked Questions.”
Baverstock, K. Environmental Health Perspectives, May 2006.
Health Physics Society: “Doses from Medical X-Ray Procedures.”
The Mayo Clinic: “Radiation Sickness.”
World Health Organization.
International Atomic Energy Agency.