Acute radiation syndrome: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Bone Marrow Syndrome | |||
*Gastrointestinal (GI) Syndrome | |||
*Cardiovascular (CV)/Central Nervous System (CNS) Syndrome | |||
===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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==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>== | |||
*Each ARS syndrome typically progresses through 4 stages of disease | *Each ARS syndrome typically progresses through 4 stages of disease | ||
===Prodromal Stage=== | ====Prodromal Stage==== | ||
*Characterized by nausea and vomiting | *Characterized by nausea and vomiting | ||
**Other symptoms include: malaise, fever, conjunctivitis | **Other symptoms include: malaise, fever, conjunctivitis | ||
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*Lasts up to 2 days | *Lasts up to 2 days | ||
===Latent Stage=== | ====Latent Stage==== | ||
*Short period of symptom improvement | *Short period of symptom improvement | ||
*Lasts several days to 1 month | *Lasts several days to 1 month | ||
===Manifest Illness Stage=== | ====Manifest Illness Stage==== | ||
*Manifestation of symptoms of clinical syndromes | *Manifestation of symptoms of clinical syndromes | ||
*Severity based on, among other things: | *Severity based on, among other things: | ||
| Line 39: | Line 34: | ||
*Lasts for days to months | *Lasts for days to months | ||
===Recovery or Death=== | ====Recovery or Death==== | ||
*If pt survives manifest illness stage, recovery is slow (weeks to years) | *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 | *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 DDX}} | |||
==Diagnosis== | ==Diagnosis== | ||
*Clinical diagnosis, based on history and physical. | *Clinical diagnosis, based on history and physical. | ||
==Treatment== | ==Treatment== | ||
==Disposition== | ==Disposition== | ||
Revision as of 03:22, 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
- Bone Marrow Syndrome
- Gastrointestinal (GI) Syndrome
- Cardiovascular (CV)/Central Nervous System (CNS) Syndrome
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
- 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 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.
- ↑ Donnelly EH1, Nemhauser JB, Smith JM, et al. Acute radiation syndrome: assessment and management. South Med J. 2010 Jun;103(6):541-6.