Acute Radiation Syndrome: What Every Nurse Needs to Know

• Acute radiation syndrome occurs when the human body is exposed to a high dose of iodizing radiation in a very short period of time.  
• Acute radiation syndrome is commonly treated with Potassium Iodide.   
• The initial treatment for acute radiation should center around treating injuries and burns and maintaining hydration.

Acute radiation syndrome is a complex set of syndromes that humans develop secondary to short-duration whole body exposure to ionizing radiation. The hematopoietic system (components of cellular blood) is the most vulnerable to radiation followed by cutaneous exposure. 

 For humans, 5,000 millirems (mrem) is the current federal occupational limit per year for an adult and a whole-body acute exposure to 5 Gy (500,000 mrem) leads to death within 14 days. Acute radiation syndrome results from a short, high exposure (> 1 Gy) to ionizing radiation. 

 Many industries expose humans to ambient radiation daily. Aside from war, large scale radiation incidents requiring medical treatment are rare. If exposed, the clinical course of acute radiation syndrome is dose dependent on absorption and distribution.  

 As a rule of radiation safety, the Federal Emergency Management Agency (FEMA) recommends that people stay indoors for at least 24 hours after a nuclear event. For healthcare professionals there is an obligation to have a baseline understanding of what makes up acute radiation syndrome and a potential public health emergency. 

Acute Radiation Case Study

A radiological accident occurred at an industrial sterilization facility following a mechanical malfunction. The supervisor, a 66-year-old man circumventing established safety protocols, entered the exposed location to clear the malfunction and received a significant dose of radiation. 

Radiation experts estimate the supervisor received a whole-body dose of 4 Gy and experienced nausea and vomiting minutes later. Gray (Gy) refers to a unit of absorbed radiation (water, soil, air) by an object or person equal to the dose of one joule of energy absorbed per kilogram.  

 In transit to the hospital the patient developed facial and palmar erythema, abdominal tenderness and swelling of the lower eyelids. The patient arrived conscious. Blood pressure of 138/79 mm Hg, temperature of 37.9 °C, pulse rate of 114 beats/min, and respiration rate of 22 breaths/min. Several days into his hospital admission the patient developed anorexia, bruising, bleeding, generalized weakness, and dizziness. 

 Laboratory and bone marrow testing showed pancytopenia (deficiency in red cells, white cells, and platelets) and anemia. Multiple days of vomiting and diarrhea caused the patient to develop renal insufficiency and acute deterioration of his liver function. 

 Two weeks into his hospitalization the nausea and vomiting continued, overt jaundice, evolving erythema on his hands, head, and face. A radiological exam of his chest showed bilateral infiltrates in the lower lobes. Three days later the patient died.  

Physiological Insult

A lethal dose of radiation disrupts chemical bonds. Following the disruption, molecular excitation and free radical formation proliferates. The free radicals react with essential molecular structures, disrupting cellular function of the hematopoietic cells, small intestine, stomach, colon, epithelium, and skin. 

 Distinct syndromes progress, including bone marrow syndrome (destruction of the marrow) resulting in infection and hemorrhage, gastrointestinal syndrome leading to infection, dehydration, and electrolyte imbalance, and cardiovascular/central nervous syndrome leading to circulatory collapse, increased intracranial pressure (ICP), edema, vasculitis, and meningitis. Progressing through the stages of radiation exposure can lead to recovery or death and the timeline can take weeks to a handful of years. 

Acute Radiation Symptom Treatment  

Safety for staff and patients is paramount. Before treatment, patients exposed to radiation require decontamination to remove external radioactive particles. When safe, removing the patient’s clothing and shoes eliminates most external contamination. To remove skin contamination, wash with soap and water to remove radiation particles. 

The treatment of acute radiation syndrome centers on the circumstances of the exposure, including distance from the source of radiation, duration of exposure and a rough estimate of the severity of radiation sickness in the patient.  

Initial goals require prompt decontamination and the treatment of life-threatening traumatic injuries and burns.  

 The most common oral treatments include Potassium iodide (KI) which helps block the thyroid from absorbing radioactive material and counteract some effects of significant radiation exposure. 

As healthcare professionals, initial treatment for Acute Radiation Syndrome (ARS) requires a focus on maintaining hydration and treating injuries and burns.  

The Bottom Line

Acute radiation syndrome is caused by exposure to high doses of iodizing radiation over a short period of time and Potassium iodide is a common oral treatment.  

Health care professionals should focus on treating injuries and burns, as well making sure that hydration is maintained during the initial treatment of this illness.  

Read More