Management of Ionizing Radiation Injuries and Illnesses, Part 4: Acute Radiation Syndrome

Abstract

To provide proper medical care for patients after a radiation incident, it is necessary to make the correct diagnosis in a timely manner and to ascertain the relative magnitude of the incident. The present article addresses the clinical diagnosis and management of high-dose radiation injuries and illnesses in the first 24 to 72 hours after a radiologic or nuclear incident. To evaluate the magnitude of a high-dose incident, it is important for the health physicist, physician, and radiobiologist to work together and to assess many variables, including medical history and physical examination results; the timing of prodromal signs and symptoms (eg, nausea, vomiting, diarrhea, transient incapacitation, hypotension, and other signs and symptoms suggestive of high-level exposure); and the incident history, including system geometry, source-patient distance, and the suspected radiation dose distribution.

Serum microRNAs are early indicators of survival after radiation-induced hematopoietic injury

“…The radiation median lethal dose (LD 50 ) for untreated humans is about 4 Gy (4). Low to moderate radiation exposures in humans lead to progressive development of acute radiation syndrome (ARS) consisting of dose-dependent hematopoietic, gastrointestinal, and cerebro-vascular malignancies (2).…”

Diagnostic Criteria for Assessment by General Practitioners of Patients Injured in Radiation Incidents and Cases of Radiological Terrorism

“…In Table 1 we present the lymphocyte count changes in the initial days following whole body exposure. 12,15,[30][31][32] If possible, additional lab probes may be obtained in the initial diagnostic stages (although there is no consensus on some of them) as follows, to serve as the basis for development and confirmation of the diagnosis: differential blood count; changes in serum amylase; reduced concentration of serum citrulline as a biomarker of radiation-induced impairment of gut mucosa; increased values of C-reactive protein (CRP); increased concentration of FMS-like tyrosine kinase 3 (FLT-3) ligand, which can be used to assess the severity of radiation impairment. Using blood samples for the cytogenetic study of chromosomal aberrations in peripheral blood lymphocytes is known as the "gold standard" of biological dosimetry.…”

Mitigating Effects of 1-Palmitoyl-2-linoleoyl-3-acetyl-rac-glycerol (PLAG) on Hematopoietic Acute Radiation Syndrome after Total-Body Ionizing Irradiation in Mice

“…Ionizing radiation releases very high energy, which damages molecular components in cells of various tissues (4). DNA is the most susceptible target of radiation, and its damage results in chromosomal aberrations, mutations and eventually cellular death (38,39).…”

“…ARS has been traditionally divided into three sub-syndromes, each with a specific dose threshold for the appearance of clinical symptoms: hematopoietic sub-syndrome (H-ARS, 1-6 Gy), gastrointestinal sub-syndrome (GI-ARS, 6-8 Gy), and neurovascular subsyndrome (.10 Gy) (2-4). However, because the damage caused by radiation is not confined to one isolated system, irradiated patients require immediate intensive care to minimize damage to other systems (4).…”