A disease caused by exposure to ionizing radiation is called radiation sickness. In both humans and animals, it can affect almost all organs and systems: skin, bone marrow, nervous system, digestive organs, endocrine glands, and so on. Radiation sickness often results in various types of oncology.
People come into contact with powerful sources of ionizing radiation during X-ray examinations or during treatment using radioactive drugs, as well as those who have been in areas of increased radioactivity (emergency nuclear power plants, or areas where atomic weapons were used or tested).
Flows of alpha particles, beta particles or neutrons, as well as electromagnetic radiation of very high frequency: x-rays and gamma rays, are ionizing.
Features of the disease
As a result of radiation sickness, the normal functioning of the body at the cellular and molecular levels ceases. Protein structures and cellular metabolism are disrupted, genome mutations occur, and catalytic pathways are blocked.
The disease leads to the rapid accumulation of “garbage”, non-functional components in all systems of the body at the intracellular and intercellular levels, which causes radiation toxemia, that is, poisoning. Mass death of groups of cells begins, organs function poorly, the functioning of lymph nodes, the absorptive layer of the intestine, bone marrow cells, and so on is disrupted.
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It has been repeatedly noted that ionizing radiation is an invisible killer. Humans do not have sense organs that perceive such radiation. Being under the influence of a deadly radiation background, people do not feel any pain, no burning, or any special sensations at all.
Human exposure to very high doses of radiation
- 6–10 Gy – a transitional form of the disease develops, occurring with severe bone marrow syndrome and severe intestinal damage.
- 10–20 Gy – the intestines are affected (intestinal syndrome), resulting in death after 8–16 days.
- 20–80 Gy – toxic syndrome with clinical manifestations in the form of vascular disorders and metabolic disorders is observed; death occurs on the 4th–7th day.
- over 80 Gy – cerebral syndrome occurs (collapse, convulsions and other neurological disorders), ending in death in the first hours or days.
At a dose of more than 100 Gy, neurons almost completely die, the nervous system fails, causing a disruption in the functioning of all organs and metabolism, which ultimately affects the brain and death occurs within a few hours.
It is worth noting that the younger the age of the irradiated person at the time of radionuclides entering the body, the higher the likelihood of an increase in the incidence of malignant tumors of the pituitary gland, adrenal glands and thyroid gland. Young people are 3-5 times more likely to develop cancer than adults.
A total dose of about 10 Gy received by children over several weeks causes abnormalities of the musculoskeletal system. The younger the child, the more bone growth is suppressed, leading to a partial or complete stop in the development of cartilage tissue and the development of skeletal abnormalities.
Maximum radiation dose received by a person
The highest dose of radiation was received in 1959 by employee K., working at the Los Alamos National Laboratory, as a result of a failed plutonium mining installation - 39000-49000 mSv. The upper half of his body was exposed to more radiation than the lower half, so the most severe pathological changes affected the hematopoietic and urinary systems. This is how the documents describe the condition of the irradiated person: after the eighth hour, the patient had completely no lymphocytes in the blood, and the urinary tract, despite the introduction of a large amount of fluid, almost completely failed. Despite the therapeutic measures taken, he died 34 hours and 45 minutes after sudden cardiac arrest.
Degrees of the disease
Short-term and not too strong radiation, or radiation trauma, causes reversible damage to the body. The degrees of the disease are divided according to the power and duration of radiation, in other words, depending on the radiation dose received.
In the first (mild) degree, nausea, vomiting, trembling of the arms and legs, and palpitations occur. Everything goes away after rehabilitation treatment.
In the second (medium) degree, skin rashes appear, movements and reflexes are impaired, hair falls out, and blood pressure decreases. In the absence of treatment - transition to the third degree.
In the third (severe) degree, the symptoms characteristic of the second degree intensify, immunity decreases, the course of chronic and infectious diseases worsens, and severe intoxication occurs, accompanied by bleeding.
In the fourth (extremely severe) degree, the temperature rises, blood pressure drops sharply, necrotic ulcers appear, and cerebral edema develops with death occurring in two to three days.
Publications in the media
Radiation sickness (RS) is a disease caused by exposure of the body to ionizing radiation in doses exceeding the maximum permissible.
Etiology • Use of nuclear weapons (including testing) • Accidents in industry and nuclear energy • Eating radioactively contaminated foods (internal exposure) • Radiation therapy • Chronic LB - employees of the departments of radiation diagnostics and therapy.
Pathomorphology • Bone marrow - reduced cell content • Necrosis of the intestinal epithelium • Fibrosis of organs long after irradiation as a result of activation of fibroblasts.
Terminology • The concept of “radiation” includes: •• a-Particles - the nuclei of helium atoms. The penetrating power is minimal •• b-Particles are electrons. They have a low damaging effect when exposed to external influences (low penetrating ability), the most dangerous when ingested into the body (the so-called internal irradiation) •• g-Radiation - a flux of photons that occurs when the energy state of atomic nuclei changes, has a pronounced penetrating ability • Indicators of radiation exposure •• 1 Rad - absorption of 100 ergs of energy by biological tissue weighing 1 g •• 1 Roentgen (R) - dose unit of x-ray and g-radiation: with a dose of 1 R in 1 ml of air, such a number of positive and negative ions are formed that their charge equal to 1 electrostatic unit in the CGS system (each sign) •• 1 Gray (Gy) = 100 rad •• Rem ( biological equivalent of rad ) - unit of equivalent dose of ionizing radiation; 1 rem is taken to be the absorbed dose of any type of ionizing radiation that, during chronic irradiation, causes the same biological effect as an absorbed dose of X-ray or g-radiation of 1 rad; 1 rem = 0.01 J/kg •• 1 sievert (Sv) = 100 rem.
Classification
• Acute LB. Symptoms develop within 24 hours after exposure. The severity and clinical picture depend on the radiation dose •• When exposed to a dose of less than 100 rad, radiation injury is possible; the changes are reversible •• When irradiated with a dose of 100–1,000 rad, the bone marrow form of LB develops. Degrees of severity: ••• I - dose 100-200 rad ••• II - dose 200-400 rad ••• III - dose 400-600 rad ••• IV - dose 600-1000 rad •• When irradiated with a dose of 1,000 –5,000 rads, a gastrointestinal variant of acute LB develops, accompanied by severe gastrointestinal bleeding. Disturbances of hematopoiesis are significantly delayed •• When irradiated with a dose of more than 5,000 rad, a neurovascular variant of LB develops, characterized by the occurrence of cerebral edema and decerebration.
• Chronic LB occurs as a result of long-term, repeated exposure to ionizing radiation in relatively low doses. The probability of detecting a remote genetic or somatic effect of radiation is 10–2 per 1 Gy.
Clinical picture (other things being equal, irradiation conditions, clinical manifestations are more pronounced in young men)
• LB syndromes •• Hematological ••• Reactive leukocytosis in the first day after irradiation is replaced by leukopenia. In the leukocyte formula - a shift to the left, relative lymphopenia, from the 2nd day after irradiation absolute lymphopenia (can persist throughout life). The degree of lymphopenia has prognostic significance (more than 1.5´109/l - normal content; more than 1´109/l - survival is possible without treatment; 0.5–1´109/l - survival is possible with long-term conservative treatment; 0.1 –0.4´109/l - bone marrow transplantation is required; less than 0.1´109/l - high probability of death.) ••• Granulocytopenia develops 2-3 weeks after irradiation and resolves faster the earlier it is detected (on average - 12 weeks). Recovery from granulocytopenia is rapid (1–3 days), no relapses are noted ••• Anemia. When leukopoiesis is restored, a reticulocyte crisis is possible, but restoration of the level of erythrocytes occurs much later than that of leukocytes ••• Thrombocytopenia occurs when irradiated with a dose of more than 200 rad no earlier than the end of the first week after irradiation. The restoration of the platelet count is often 1–2 days ahead of the restoration of the leukocyte count. •• Hemorrhagic syndrome is caused by deep thrombocytopenia (less than 50´109/l), as well as changes in the functional properties of platelets •• Skin ••• Hair loss, primarily on the head. Hair restoration occurs within 2 weeks if the radiation dose is not higher than 700 rad ••• Radiation dermatitis: the most sensitive skin is the armpits, inguinal folds, elbows, and neck. Forms of damage: primary erythema develops at a dose above 800 rads, is replaced by swelling of the skin, and at doses above 2,500 rads, after 1 week it turns into necrosis or is accompanied by the formation of blisters; Secondary erythema occurs some time after primary erythema, and the shorter the period of appearance, the higher the radiation dose. Peeling of the skin, slight atrophy, and pigmentation are possible in the absence of a violation of the integrity of the integument, if the radiation dose does not exceed 1,600 rad. At higher doses, swelling and blisters appear. If the skin vessels are intact, secondary erythema ends with the development of pigmentation with compaction of the subcutaneous tissue, but subsequently, cancerous degeneration of the scars formed at the site of the blisters is possible. When skin vessels are damaged, radiation ulcers develop •• Damage to the oral mucosa - with a dose above 500 rads occurs on days 3–4. Swelling of the mucous membrane appears, dry mouth, saliva becomes viscous, causing vomiting. Ulcerative stomatitis is observed when the oral mucosa is irradiated at a dose above 1,000 rad, its duration is 1–1.5 months. Against the background of leukopenia, secondary infection of the mucous membranes is possible. Starting from 2 weeks, dense white plaques form on the gums - hyperkeratosis. Unlike thrush, plaque in hyperkeratosis cannot be removed with a spatula; there is no fungal mycelium in the smears •• Damage to the gastrointestinal tract - with external uniform irradiation with a dose of over 300–500 rad or with internal irradiation ••• Radiation gastritis - nausea, vomiting, pain in the epigastric region ••• Radiation enteritis - abdominal pain, diarrhea ••• Radiation colitis - tenesmus, blood in the stool ••• Radiation hepatitis - moderate cholestatic syndrome, cytolysis. The course is undulating for several months, progression to liver cirrhosis is possible •• Damage to the endocrine system ••• Strengthening the functions of the pituitary-adrenal system in the early stages as part of a stress reaction ••• Inhibition of the functions of the thyroid glands, especially with internal irradiation with radioactive iodine. Possible malignancy ••• Inhibition of the functions of the gonads •• Damage to the nervous system ••• Psychomotor agitation as part of the primary reaction ••• Diffuse inhibition of the cerebral cortex replaces psychomotor agitation ••• Disruption of the nervous regulation of internal organs, autonomic dysfunction ••• With neurovascular syndrome (irradiation with a dose of more than 5,000 rad) - tremor, ataxia, vomiting, arterial hypotension, convulsive attacks. Lethal outcome in 100% of cases.
• Periods of acute LB •• Primary radiation reaction begins immediately after irradiation, lasts several hours or days ••• Nausea, vomiting ••• Excited or lethargic state ••• Headache •• The period of imaginary well-being lasts from several days to a month (than the lower the dose, the longer it is; at a dose over 400 rads do not occur at all), is characterized by subjective well-being, although functional and structural changes in tissues continue to develop •• The peak period is 3–4 weeks, the above clinical syndromes develop •• The recovery period - duration of several weeks or months (the higher the radiation dose, the longer it is). A favorable prognostic sign is positive dynamics of lymphocyte content.
• Features of acute LB with uneven irradiation •• The period of imaginary well-being is shortened •• The clinic of the peak period is determined by the functional significance of the body area that received the maximum radiation dose. Hematological syndrome may recede into the background, giving way to manifestations of damage to the gastrointestinal tract or nervous system.
• Features of acute LB from internal irradiation •• The primary reaction is erased •• The period of imaginary well-being is short •• The peak period is long, has a wave-like course ••• Hemorrhagic syndrome occurs rarely ••• Skin damage is rare ••• Damage to the mucous membranes of the gastrointestinal tract is often observed ••• Accumulation in tissues depends on the type of radioactive element: lanthanum, cerium, actinium, thorium accumulate in the liver, radioactive iodine in the thyroid gland, strontium, uranium, radium, plutonium in the bones •• The recovery period is long.
• Periods of chronic LB •• Formation period. Among the LB syndromes, the most common are ••• Hematological syndrome (thrombocytopenia, leukopenia, lymphopenia) ••• Asthenovegetative syndrome ••• Trophic disorders: brittle nails, dry skin, hair loss •• The recovery period is possible only if exposure to radiation is stopped •• Period long-term consequences and complications ••• Acceleration of aging processes: atherosclerosis, cataracts, early decline of the functions of the gonads ••• Progression of chronic diseases of internal organs that occurred latently during the period of formation (chronic bronchitis, cirrhosis of the liver, etc.).
Laboratory tests • CBC: Hb, content of erythrocytes, leukocytes, lymphocytes, granulocytes • Feces for occult blood • Analysis of bone marrow aspirate • Microscopy of scrapings from the oral mucosa • Bacteriological blood cultures for sterility - in case of fever.
Special studies • Dosimetric monitoring • Neurological examination.
TREATMENT
General tactics • For acute LB •• Bed rest •• For the prevention of exogenous infections, patients are treated under aseptic conditions (boxes, air sterilization using UV rays) •• Diet: fasting and drinking water - for necrotizing enterocolitis •• Decontamination (surface treatment skin, gastric and intestinal lavage during internal irradiation) •• Detoxification ••• Intravenous infusions of hemodesis, saline solutions, plasma substitutes ••• Forced diuresis •• Antiemetics •• Blood transfusions ••• Platelet suspension for thrombocytopenia ••• Erythrocyte mass with anemia. When Hb >83 g/l without signs of acute blood loss, red blood cell transfusion is not recommended, because this can further aggravate radiation damage to the liver, enhance fibrinolysis • In acute LB due to internal irradiation •• Drugs that displace radioactive substances ••• In case of infection with radioactive iodine - potassium iodide ••• In case of infection with radioactive phosphorus - magnesium sulfate ••• In case of infection isotopes that accumulate in bone tissue - calcium salts •• Mild laxatives to accelerate the passage of radioactive substances through the gastrointestinal tract • For chronic LB - replacement and antibacterial therapy, as with other types of LB.
Drug therapy • Antiemetics: atropine (0.75–1 ml 0.1% solution) subcutaneously • Antibiotics •• To suppress the proliferation of microorganisms that normally live in the small intestine, with gastrointestinal syndrome ••• Kanamycin 2 g/day orally ••• Polymyxin B up to 1 g/day ••• Nystatin 10–20 million units/day ••• Co-trimaxozole 1 tablet 3 times a day ••• Ciprofloxacin 0.5 g 2 times a day •• For the treatment of fever due to neutropenia ••• The most optimal combination is aminoglycosides (gentamicin 1–1.7 mg/kg every 8 hours) and penicillins active against Pseudomonas aeruginosa (for example, azlocillin 250 mg /kg/day) ••• If fever persists for more than 3 days, first generation cephalosporins are added to the specified combination ••• If fever persists for 5-6 days, antifungal agents are additionally prescribed (amphotericin B 0.7 mg/kg/day).
Surgical treatment • It is necessary to carry out primary surgical treatment of wounds before decontamination • All surgical interventions for combined lesions are carried out within the first 2 days to prevent leukopenia and platelet dysfunction • Bone marrow transplantation - in case of its aplasia, confirmed by the results of bone marrow puncture.
Complications • Long-term fibrosis of the kidneys, liver and lungs - after irradiation with a dose of over 300 rad • Malignant neoplasms of various locations • Increased risk of leukemia (more often - acute lymphocytic, chronic myeloid leukemia) • Infertility.
Course and prognosis • Patients who survive 12 weeks have a favorable prognosis, but observation is necessary to exclude long-term complications • Complete recovery from chronic LB is impossible • When planning a family, medical genetic consultation is important.
Pregnancy. Even the lowest doses of radiation have a damaging effect on the fetus.
Prevention • Personal protective equipment (gas masks) • Mass protective equipment (shelters) • Increasing the reliability of industrial production associated with the use of radioactive substances.
Reduction. RB - radiation sickness
ICD-10. • D61.2 Aplastic anemia caused by other external agents • J70.0 Acute pulmonary manifestations caused by radiation • J70.1 Chronic and other pulmonary manifestations caused by radiation • K52.0 Radiation gastroenteritis and colitis • K62.7 Radiation proctitis • M96. 2 Post-radiation kyphosis • M96.5 Post-radiation scoliosis • L58 Radiation [radiation] dermatitis • L59 Other diseases of the skin and subcutaneous tissue associated with radiation • T66 Unspecified effects of radiation
Notes • Acute radiation syndrome occurred in 120,000 people in Japan as a result of nuclear explosions • The Chernobyl accident in 1986 resulted in approximately 50,000 people being exposed to radiation.
Treatment
People affected by radiation sickness are hospitalized in sterile conditions. Immediately treat the skin with antiseptics and wash the stomach.
On the first day, saline solutions and plasma replacement solutions are administered to remove toxins. Subsequent treatment depends on the identified injuries and infections. In severe cases, a bone marrow transplant is performed, without which the risk of death is very high.
After radiation sickness, the patient is considered incapacitated for about six months; in mild cases, this period can be reduced to three months. In the future, exacerbations of the course of chronic and infectious diseases, the development of anemia, leukemia, various degenerative changes, cancer, and genetic changes are possible.
Problems of identifying probabilistic lesions
Genetic mutations - chromosomal aberrations and changes in genes, can either provoke the occurrence of hereditary diseases in subsequent generations or not manifest themselves at all. UNSCEAR data are known about severe pathologies found in more than 27 thousand children whose parents received large doses of radiation during the atomic bombings of Nagasaki and Hiroshima. Only two probable mutations were found in them, while no genetic disorders were found in children whose parents were less exposed to radiation.
Therefore, it is almost impossible to identify, much less predict, the appearance of a stochastic effect in an individual person. Only long-term observations over large groups of people who have received a considerable dose of radiation make it possible to establish morbidity or mortality rates due to the effects of ionizing radiation. In this case, the yield is determined by the collective dose, if it is at least 1000 man Sv.
The mutagenic effect of radiation on living cells was established by Russian scientists R.A. Nadson and R.S. Filippov in 1925, conducting experiments on yeast fungi. In 1927, R. Möller confirmed the scientists' conclusions using a classic object for genetic research - the Drosophila fly.
Biological manifestations of radiation in high doses
Large doses - a very wide range of values (from 1 Gy to 10 Gy) - a wide range of radiobiological, epidemiological and medical consequences of radiation, ranging from an adaptive response and hormesis to a severe form of radiation sickness at the upper limit of the range. First of all, high doses of radiation cause post-irradiation cell death, as a result of which they lose the ability to reproduce. The peculiarity of the damage is that the cell does not die immediately, but after 1-5 divisions and does not reproduce full cells due to DNA breaks. This happens at all levels of the body:
1. Red bone marrow loses the ability to produce white blood cells, as a result of which the body's defenses in the fight against infectious diseases are reduced. Reduces the number of red blood cells and platelets responsible for blood clotting, the walls of blood vessels are damaged and hemorrhages occur. If part of it has been irradiated, then the surviving brain cells are usually sufficient to completely replace the damaged cells.
2. The lens of the eye is another organ that is sensitive to radiation. When exposed to 2 Gy of ionizing radiation, its cells become opaque, causing the development of cataracts. A dose of about 5 Gy leads to progressive cataracts, a serious disease leading to loss of vision.
3. The genitals stop temporarily or permanently producing eggs and sperm. Long-term exposure to large doses of radiation of 3.5–6 Gy, provided that a dose of about 2 Gy has accumulated over the year, leads to permanent sterilization. A single dose of 0.5 Gy suppresses spermatogenesis for up to 8 months; only after many years will the testes be able to resume the production of full-fledged sperm. Women's ovaries are more resistant to radiation and stop producing full-fledged eggs with a single dose of 3 Gy, and a single irradiation of 0.1 Gy leads to temporary sterilization.
In this case, the irradiated person does not experience radiation burns, but can lead to erythema, temporary or permanent baldness.
Prevention
Radiation sickness is non-contagious, that is, it is not transmitted from person to person, except for cases when the patient became a source of ionizing radiation due to the entry of radioactive substances into his body (dust settled on clothes, on the skin and in the lungs, food containing radioactive components and etc).
When working with radioactive substances and objects, as well as in areas with high levels of ionizing radiation, shielding devices should be used, as well as devices that monitor the received radiation dose. Those in risk areas are recommended to take vitamins B6, C, P, as well as anabolic-type hormonal agents.
What is beta radiation?
There are different types of radiation that affect the body in their own way. Since the study of this topic began relatively recently, scientists cannot yet say with accuracy how much damage is caused to the body by this or that radiation. The types of radiation sickness can largely depend on what kind of radiation a person was exposed to.
The following types of radioactive radiation are distinguished:
- Alpha radiation. This type of radiation has the least penetrating ability, but can cause great harm to the body. Once inside the body through food or air, alpha particles are not removed from it and can accumulate for many years. This all leads to the fact that accumulated particles cause irreversible changes and mutations.
- Beta radiation. Unlike alpha particles, particles of this radiation have a higher penetrating power. But beta radiation is generally capable of affecting only the upper tissues of the body at points of contact or accumulating in the body itself. This type of radiation is the most gentle, but it is also the most common.
- Gamma radiation. Although this radiation has a higher penetrating ability compared to the previous two types, it has a weak effect on the biological organism.
- Neutron radiation. This species has not been studied well enough to make accurate and definitive conclusions about its danger. But it is already known that this is one of the most dangerous radiations for humans. This species is found during atomic explosions and, due to the fact that neutron radiation has a high mass, it can cause enormous damage to the cells of a living organism.
All these types of radiation affect people differently, but they should not be underestimated. Even the weakest radiation can lead to serious consequences over time. After all, everything depends not only on the dose of radiation, but also on the period of time during which the person was exposed to negative effects.
Radiation levels in Chernobyl today
While on the first day after this disaster, April 26, 1986, background radiation in the city of Pripyat could be up to 1 Roentgen per hour, today it does not exceed 100-200 microRoentgen per hour. In the urban-type settlement of Polesskoye and on the highway leading to it, it is 150-200 micro-Roentgen per hour. This zone is considered a “dirty” area located in the “Western Trace” - during the fire at the nuclear power plant, the wind carried a significant part of the radioactive substances here in the form of precipitation.
Should I be afraid of radiation sickness at such radiation levels? Definitely not. It is still forbidden to live in such areas, but it is relatively safe to move around them, especially if the clothing is then subjected to special treatment. For comparison: on an airplane at an altitude of 7-9 kilometers, ordinary passengers are in a field of radioactive radiation of 400-700 micro-Roentgen per hour, and we are used to experiencing this without any special health problems. The drop in radiation levels in the vicinity of Chernobyl is associated both with the decay of short-lived isotopes and with the heroic work of liquidators in decontamination: they washed houses of particles and resurfaced the road surface.
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Where can you get a high dose of radiation?
There are no places in nature where you can receive a large dose of radiation in a short time. The exceptions are provinces where the population receives average annual doses that exceed the established limit by 5-10 times.
For example, in the Indian state of Kerala the dose is 5 mSv, in the Brazilian city of Guarapari - 5.5 mSv. But people living in these areas have adapted to the increased dose of radiation; among them there is no increased mortality or incidence of cancer.
For other citizens, the main sources of potential danger of receiving radiation in high (over 1000 mSv) doses are man-made: accidents and explosions at nuclear power plants, nuclear tests, instruments and devices that contain radioactive substances.
