Signs and Symptoms
Classically acute radiation syndrome is divided into three main presentations: hematopoietic, gastrointestinal and neurological/vascular. These symptoms may or may not be preceded by a prodrome. The speed of onset of symptoms is related to radiation exposure, with greater doses resulting in a shorter delay in symptom onset. These presentations presume whole-body exposure and many of them are markers which are not valid if the entire body has not been exposed. Each syndrome requires that the tissue showing the syndrome itself be exposed. The hematopoetic syndrome requires exposure of the areas of bone marrow actively forming blood elements (i.e., the pelvis and sternum in adults). The neurovascular symptoms require exposure of the brain. The gastrointestinal syndrome is not seen if the stomach and intestines are not exposed to radiation.
- Hematopoietic. This syndrome is marked by a drop in the number of blood cells, called aplastic anemia. This may result in infections due to low white blood cells, bleeding due to low platelets, and anemia due to low red blood cells. These changes can be detected by blood tests after receiving a whole-body acute dose as low as 0.25 Gy, though they might never be felt by the patient if the dose is below 1 Gy. Conventional trauma and burns resulting from a bomb blast are complicated by the poor wound healing caused by hematopoietic syndrome, increasing mortality.
- Gastrointestinal. This syndrome often follows absorbed doses of 6–30 Gy (600–3000 rad). Nausea, vomiting, loss of appetite, and abdominal pain are usually seen within two hours. Vomiting in this time-frame is a marker for whole body exposures that are in the fatal range above 4 Gy. Without exotic treatment such as bone marrow transplant, death with this dose is common. The death is generally more due to infection than gastrointestinal dysfunction.
- Neurovascular. This syndrome typically occurs at absorbed doses greater than 30 Gy (3000 rad), though it may occur at 10 Gy (1000 rad). It presents with neurological symptoms such as dizziness, headache, or decreased level of consciousness, occurring within minutes to a few hours, and with an absence of vomiting. It is invariably fatal.
The prodrome (early symptoms) of ARS typically includes nausea and vomiting, headaches, fatigue, fever and short period of skin reddening. These symptoms may occur at radiation doses as low as 35 rad (0.35 Gy). These symptoms are common to many illnesses and may not, by themselves, indicate acute radiation sickness.
| Phase | Symptom | Whole-body absorbed dose (Gy) | ||||
|---|---|---|---|---|---|---|
| 1–2Gy | 2–6Gy | 6–8Gy | 8–30Gy | Greater Than 30Gy | ||
| Immediate | Nausea and vomiting | 5–50% | 50–100% | 75–100% | 90–100% | 100% |
| Time of onset | 2–6h | 1–2h | 10–60 min | < 10 min | Minutes | |
| Duration | < 24h | 24–48h | < 48h | < 48h | N/A (patients die in < 48h) | |
| Diarrhea | None | None to mild (<10%) | Heavy (>10%) | Heavy (>95%) | Heavy (100%) | |
| Time of onset | — | 3–8h | 1–3h | < 1h | < 1h | |
| Headache | Slight | Mild to moderate (50%) | Moderate (80%) | Severe (80–90%) | Severe (100%) | |
| Time of onset | — | 4–24h | 3–4h | 1–2h | < 1h | |
| Fever | None | Moderate increase (10-100%) | Moderate to severe (100%) | Severe (100%) | Severe (100%) | |
| Time of onset | — | 1–3h | < 1h | < 1h | < 1h | |
| CNS function | No impairment | Cognitive impairment 6–20 h | Cognitive impairment > 24h | Rapid incapacitation | Seizures, Tremor, Ataxia, Lethargy | |
| Latent period | 28–31 days | 7–28 days | < 7 days | none | none | |
| Illness | Mild to moderate Leukopenia Fatigue Weakness |
Moderate to severe Leukopenia Purpura Hemorrhage Infections Epilation after 3 Gy |
Severe leukopenia High fever Diarrhea Vomiting Dizziness and disorientation Hypotension Electrolyte disturbance |
Nausea Vomiting Severe diarrhea High fever Electrolyte disturbance Shock |
N/A (patients die in < 48h) | |
| Mortality | Without care | 0–5% | 5–100% | 95–100% | 100% | 100% |
| With care | 0–5% | 5–50% | 50–100% | 100% | 100% | |
| Death | 6–8 wks | 4–6 wks | 2–4 wks | 2 days–2 wks | 1–2 days | |
Read more about this topic: Biological Timeline Of Radiation Poisoning
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