Diagnosis
When a person has experienced known or probable exposure to a high dose of radiation from an accident or attack, medical personnel take a number of steps to determine the absorbed radiation dose. This information is essential for determining how serious the illness is likely to be, which treatments to use and whether a person is likely to survive.
Information important for determining an absorbed dose includes:
- Known exposure. Details about distance from the source of radiation and duration of exposure can help provide a rough estimate of the severity of radiation sickness.
- Vomiting and other symptoms. The time between radiation exposure and when vomiting starts is a fairly accurate screening tool to estimate absorbed radiation dose. The shorter the time before vomiting starts, the higher the dose. The severity and timing of other symptoms also may help medical personnel determine the absorbed dose.
- Blood tests. Frequent blood tests over several days enable medical personnel to look for drops in disease-fighting white blood cells and unusual changes in the DNA of blood cells. These factors indicate the degree of bone marrow damage, which is determined by the level of an absorbed dose.
- Dosimeter. A device called a dosimeter can measure the absorbed dose of radiation but only if it was exposed to the same radiation event as the affected person.
- Survey meter. A device such as a Geiger counter can be used to test people to see where in the body radioactive particles are located.
- Type of radiation. A part of the larger emergency response to a radioactive accident or attack would include identifying the type of radiation exposure. This information would guide some decisions for treating people with radiation sickness.
Treatment
The treatment goals for radiation sickness are to prevent further radioactive contamination; treat life-threatening injuries, such as from burns and trauma; reduce symptoms; and manage pain.
Decontamination
Decontamination involves removing external radioactive particles. Removing clothing and shoes eliminates about 90% of external contamination. Gently washing with water and soap removes additional radiation particles from the skin.
Decontamination prevents radioactive materials from spreading more. It also lowers the risk of internal contamination from inhalation, ingestion or open wounds.
Treatment for damaged bone marrow
A protein called granulocyte colony-stimulating factor, which promotes the growth of white blood cells, may counter the effect of radiation sickness on bone marrow. Treatment with this protein-based medicine, which includes filgrastim (Neupogen), sargramostim (Leukine) and pegfilgrastim (Neulasta), may increase white blood cell production and help prevent subsequent infections.
If you have severe damage to bone marrow, you may also receive transfusions of red blood cells or blood platelets.
Treatment for internal contamination
Some treatments may reduce damage to internal organs caused by radioactive particles. Medical personnel would use these treatments only if you've been exposed to a specific type of radiation. These treatments include the following:
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Potassium iodide. This is a nonradioactive form of iodine. Iodine is essential for proper thyroid function. If you're exposed to significant radiation, your thyroid will absorb radioactive iodine (radioiodine) just as it would other forms of iodine. The radioiodine is eventually cleared from the body in urine.
If you take potassium iodide, it may fill "vacancies" in the thyroid and prevent the absorption of radioiodine. Potassium iodide isn't a cure-all and is most effective if taken within a day of exposure.
- Prussian blue (Radiogardase). This type of dye binds to particles of radioactive elements known as cesium and thallium. The radioactive particles then pass out of the body in feces. This treatment speeds up the elimination of the radioactive particles and reduces the amount of radiation cells may absorb.
- Diethylenetriamine pentaacetic acid (DTPA). This substance binds to metals. DTPA binds to particles of the radioactive elements plutonium, americium and curium. The radioactive particles pass out of the body in urine. That lowers the amount of radiation absorbed.
Supportive treatment
If you have radiation sickness, you may receive additional medicines or interventions to treat:
- Bacterial infections.
- Headache.
- Fever.
- Diarrhea.
- Nausea and vomiting.
- Dehydration.
- Burns.
- Sores or ulcers.
End-of-life care
A person who has absorbed very large doses of radiation has little chance of recovery. Depending on the severity of illness, death can occur within two days or two weeks. People with a lethal radiation dose receive medicine to control pain, nausea, vomiting and diarrhea. They also may benefit from psychological or pastoral care.