Radiation sickness can be acute or chronic. Symptoms, signs and treatments for radiation sickness

Modern people have a vague understanding of radiation and its consequences, because the last large-scale disaster occurred more than 30 years ago. Ionizing radiation is invisible, but can cause dangerous and irreversible changes in the human body. In large, single doses, it is absolutely lethal.

What is radiation sickness?

This term refers to a pathological condition provoked by exposure to any type of radiation. It is accompanied by symptoms that depend on several factors:

• type of ionizing radiation;
• dose received;
• the rate at which radiation exposure enters the body;
• source localization;
• dose distribution in the human body.

Acute radiation sickness

This pathology occurs as a result of uniform exposure to large amounts of radiation. Acute radiation sickness develops at radiation doses exceeding 100 rad (1 Gy). This volume of radioactive particles must be obtained once, over a short period of time. Radiation sickness of this form immediately causes noticeable clinical manifestations. At doses of more than 10 Gy, a person dies after short suffering.

Chronic radiation sickness

The type of problem under consideration is a complex clinical syndrome. The chronic course of the disease is observed if the doses of radioactive radiation are low, amounting to 10-50 rads per day for a long time. Specific signs of pathology appear when the total amount of ionization reaches 70-100 rad (0.7-1 Gy). The difficulty of timely diagnosis and subsequent treatment lies in the intensive processes of cellular renewal. Damaged tissues are restored, and symptoms remain unnoticeable for a long time.

The characteristic signs of the described pathology arise under the influence of:

• x-ray radiation;
• ions, including alpha and beta;
• gamma rays;
• neutrons;
• protons;
• muons and other elementary particles.

Causes of acute radiation sickness:

• man-made disasters in the field of nuclear energy;
• use of total irradiation in oncology, hematology, rheumatology;
• use of nuclear weapons.

Chronic radiation sickness develops against the background of:

• frequent x-ray or radionuclide studies in medicine;
• professional activities related to ionizing radiation;
• consuming contaminated food and water;
• living in a radioactive area.

Forms of radiation sickness

The types of pathology presented are classified separately for the acute and chronic nature of the disease. In the first case, the following forms are distinguished:

1. Bone marrow. Corresponds to a radiation dose of 1-6 Gy. This is the only type of pathology that has degrees of severity and periods of progression.
2. Transitional. Develops after exposure to ionizing radiation at a dose of 6-10 Gy. A dangerous condition, sometimes resulting in death.
3. Intestinal. Occurs when exposed to radiation of 10-20 Gy. Specific signs are observed in the first minutes of the lesion, death occurs after 8-16 days due to the complete loss of the intestinal epithelium.
4. Vascular. Another name is the toxemic form of acute radiation sickness, corresponding to an ionization dose of 20-80 Gy. Death occurs within 4-7 days due to severe hemodynamic disturbances.
5. Cerebral (fulminant, acute). The clinical picture is accompanied by loss of consciousness and a sharp drop in blood pressure after exposure to radiation of 80-120 Gy. Lethal outcome is observed in the first 3 days, sometimes a person dies within a few hours.
6. Death under the beam. At doses of more than 120 Gy, a living organism dies instantly.

Chronic radiation disease is divided into 3 types:

1. Basic. External uniform exposure to radiation over a long period of time.
2. Heterogeneous. Includes both external and internal irradiation with a selective effect on certain organs and tissues.
3. Combined. Uneven exposure to radiation (local and systemic) with a general effect on the entire body.

Degrees of radiation sickness

The severity of the violation in question is assessed according to the amount of radiation received. Degrees of manifestation of radiation sickness:

• light – 1-2 Gy;
• moderate - 2-4 Gy;
• heavy – 4-6 Gy;
• extremely severe - more than 6 Gy.

Radiation sickness - symptoms

The clinical picture of the pathology depends on its form and the degree of damage to internal organs and tissues. General signs of radiation sickness at a mild stage:

• weakness;
• nausea;
• headache;
• pronounced blush;
• drowsiness;
• fatigue;
• feeling of dryness.

Symptoms of more severe radiation exposure:

• vomit;
• fever;
• diarrhea;
• severe redness of the skin;
• fainting;
• Strong headache;
• hypotension;
• unclear pulse;
• lack of coordination;
• convulsive twitching of the limbs;
• lack of appetite;
• bleeding;
• formation of ulcers on the mucous membranes;
• hair loss;
• thinning, brittle nails;
• dysfunction of the genital organs;
• respiratory tract infections;
• trembling fingers;
• disappearance of tendon reflexes;
• decreased muscle tone;
• internal hemorrhages;
• deterioration of higher brain activity;
• hepatitis and others.

Periods of radiation sickness

Acute radiation damage occurs in 4 stages. Each period depends on the stage of radiation sickness and its severity:

1. Primary reaction. The initial stage lasts 1-5 days, its duration is calculated depending on the radiation dose received - the amount in Gy + 1. The main symptom of the primary reaction is acute, which includes 5 basic signs - headache, weakness, vomiting, redness of the skin and body temperature.
2. Imaginary well-being. The “walking corpse” phase is characterized by the absence of a specific clinical picture. The patient thinks that radiation sickness has subsided, but pathological changes in the body are progressing. The disease can be diagnosed only by abnormalities in blood composition.
3. The height of At this stage, most of the symptoms listed above are observed. Their severity depends on the severity of the lesion and the dose of ionizing radiation received.
4. Recovery. With an acceptable amount of radiation compatible with life and adequate therapy, recovery begins. All organs and systems gradually return to normal functioning.

Radiation sickness - treatment

Therapy is developed after the results of the examination of the affected person. Effective treatment of radiation sickness depends on the extent of the damage and the severity of the pathology. When receiving small doses of radiation, it comes down to relieving the symptoms of poisoning and cleansing the body of toxins. In severe cases, special therapy is required aimed at correcting all the resulting disorders.

Radiation sickness - first aid

If a person is exposed to radiation, a team of specialists should be called immediately. Before their arrival, you need to perform some manipulations.

Acute radiation sickness - treatment

Upon admission to the hospital hospital, a person is placed in a sterile room (box) to prevent infection and other complications of the described pathology. Radiation sickness requires the following therapeutic regimen:

1. Stop vomiting. Ondansetron, Metoclopramide, and the antipsychotic Chlorpromazine are prescribed. If you have an ulcer, platyphylline hydrotartrate or atropine sulfate are better options.
2. Detoxification. Droppers with physiological and glucose solutions and Dextran preparations are used.
3. Replacement therapy. Severe radiation sickness requires parenteral nutrition. For this purpose, fat emulsions and solutions with a high content of microelements, amino acids and vitamins are used - Intralipid, Lipofundin, Infezol, Aminol and others.
4. Restoration of blood composition. To accelerate the formation of granulocytes and increase their concentration in the body, Filgrastim is administered intravenously. Most patients with radiation sickness are additionally required to receive daily blood transfusions.
5. Treatment and prevention of infections. Strong ones are needed - Methyllicin, Tseporin, Kanamycin and analogues. Biological drugs, for example, hyperimmune, antistaphylococcal plasma, help increase their effectiveness.
6. Suppression of the activity of intestinal microflora and fungi. In this case, antibiotics are also prescribed - Neomycin, Gentamicin, Ristomycin. To prevent candidiasis, Nystatin and Amphotericin B are used.
7. Virus therapy. Acyclovir is recommended as a preventive treatment.
8. Fighting bleeding. Improvement of blood clotting and strengthening of vascular walls is provided by steroid hormones, Dicynon, Rutin, fibrinogen protein, and the drug E-AKK.
9. Restoring microcirculation and preventing the formation of blood clots. Heparins are used - Nadroparin, Enoxaparin and synonyms.
10. Relief of inflammatory processes. Prednisolone produces the fastest effect in small doses.
11. Prevention of collapse. Indicated, Niketamide, Phenylephrine, Sulfocamphocaine.
12. Improvement of neuroendocrine regulation. Novocaine is administered intravenously, B vitamins and calcium gluconate are additionally used.
13. Antiseptic treatment of ulcers on mucous membranes. It is recommended to rinse with soda or novocaine solution, Furacilin, hydrogen peroxide, propolis emulsion and similar means.
14. Local therapy for affected skin. Wet dressings with Rivanol, Linol, Furacilin are applied to the burned areas.
15. Symptomatic treatment. Depending on the existing symptoms, patients are prescribed sedatives, antihistamines, painkillers, and tranquilizers.

Chronic radiation sickness - treatment

The main aspect of therapy in this situation is the cessation of contact with radiation. For mild damage, it is recommended:

• fortified diet;
• physiotherapy;
• natural stimulants of the nervous system (schisandra, ginseng and others);
• bromine preparations with caffeine;
• B vitamins;
• according to indications - tranquilizers.

RADIATION SICKNESS- a disease that develops as a result of exposure to ionizing radiation in doses exceeding permissible levels. Depending on the nature of the impact (one-time massive or long-term repeated in relatively small doses), acute and chronic forms of L. b. are distinguished, respectively. varying degrees of severity with a predominance of local or general changes.

Changes in the function of the nervous and endocrine systems and dysregulation of the activity of other body systems, together with cellular and tissue lesions, form a wedge, manifestations of L. b.

The damaging effect of ionizing radiation especially affects the stem cells of hematopoietic tissue, the epithelium of the testicles, small intestine and sperm; it depends on the level and distribution of the radiation dose over time and body volume. First of all, systems that are in a state of active organogenesis and differentiation during irradiation are affected (see Critical organ). When exposed to radiation, especially in small doses, individual reactivity and function, the state of the nervous and endocrine systems are important.

Acute radiation sickness

Pathological anatomy

Most publications are descriptions of the pathological picture of acute L. b. in various experimental animals and only a few of them concern people who died in the explosion of the atomic bomb in Japan and in accidents. The most fully studied pathological anatomy of the so-called. bone marrow form of acute L. b. with predominant damage to hematopoietic tissue (see Hematopoiesis), which develops when exposed to ionizing radiation in doses of up to 1000 rad. Characteristic for this form of acute L. b. morphol, changes appear in the latent period and become pronounced during the height of the disease. In this case, signs of hemorrhagic diathesis are macroscopically detected: hemorrhages in the skin, serous and mucous membranes, and parenchymal organs. The severity of hemorrhagic diathesis varies widely depending on the severity of the lesion; additional injuries increase bleeding. Extensive hemorrhages in the stomach and intestines, in the lungs, in the adrenal glands with their destruction, extensive hemorrhages in the myocardium, involving the conduction system of the heart, can be decisive in the outcome of the disease (color. Fig. 2-4). Active bone marrow loses its normal consistency and becomes liquid, its color determined by the admixture of blood; lymph, the nodes look enlarged due to hemorrhagic saturation of the tissue. Deep disturbances in the hematopoietic system determine the tendency to bleeding and the frequency of development of inf. complications, which, as a rule, are detected during the height of the disease. These include ulcerative-necrotic gingivitis, necrotizing tonsillitis (tsvetn. Fig. 1), pneumonia, inflammatory changes in the small and large intestines. In other organs, signs of circulatory disorders and degenerative changes are found. Skin lesions (hair loss, radiation burns) can clearly manifest themselves with significant radiation exposure; in victims of the atomic explosion they were usually combined with thermal burns.

During microscopic examination, the most characteristic changes are in the hematopoietic organs, the initial signs of damage to which are detected in the latent period long before the bright wedges, manifestations of acute L. b. In the lymph nodes in the first hours after irradiation, one can see the disintegration of lymphocytes, especially in the central part of the follicles, i.e. in the area where B-lymphocytes are located; somewhat later, changes in the paracortical layer (zone of T-lymphocytes) are detected. During the height of the disease, against the background of sharp hyperemia, mainly elements of the lymph stroma, nodes and plasma cells are distinguishable. Similar changes are observed in the tonsils, spleen, group follicles (Peyer's patches) and solitary follicles. tract. Aplasia quickly develops in the bone marrow: by the third day, according to some authors, only approx. 10% of the cellular composition, which is explained by the increased release of mature forms into the peripheral bed, cessation of division and cell disintegration (interphase death); Subsequently, mitotic activity resumes for some time, but the dividing cells die during mitosis. Rapid and significant cellular devastation is accompanied by a vicarious plethora of bone marrow vessels with ruptures of the vascular walls and the formation of hemorrhage fields. During the height of acute L. b. There is almost no normal hematopoietic tissue left in the bone marrow; predominantly stromal elements and plasma cells are visible (Fig.). Damage to lymphoid tissue and bone marrow leads to a decrease in immunobiol, the body's reactivity and creates favorable conditions for the development of various complications, Ch. arr. autoinfectious nature.

During recovery, phenomena of regeneration of hematopoietic cells are detected, but even after a long time, against the background of a decrease in the total number of bone marrow cells, as a rule, a delay in cell differentiation and maturation is detected; in hematol, preparations, younger cellular elements predominate. Regeneration of lymphoid tissue occurs later than restoration of the bone marrow: in the lymph nodes a cortical layer with a diffuse arrangement of cellular elements is formed, then follicles are formed and later restoration of the paracortical layer (zone of T-lymphocytes) occurs.

With L. b. Typical changes in the gonads develop, especially in males. During the latent period, cessation of mitotic division and disintegration of the epithelium of the testicles, the appearance of individual ugly large and giant cells are detected; During the height of the disease, there is no germinal epithelium in the testicular tubules, only individual spermatogonia and Sertoli cells are preserved. Dystrophic and necrobiotic changes are observed in the ovaries, which initially occur in more mature follicles and consist in the death of eggs, and somewhat later - of the cells of the inner layer of the granular membrane.

The mucous membrane of the small intestine is highly sensitive to ionizing radiation, early changes in the cut are manifested by destruction and suppression of the mitotic activity of crypt epithelial cells with the appearance of patol, forms of mitosis. By the time pronounced wedges and signs of the disease develop, these changes, as a rule, disappear. Terminal changes are associated with disorders of blood and lymph circulation, autoinfectious processes: the mucous membrane is swollen, there are areas of ulceration and necrosis, on the surface of which molten masses of fibrin, mucus and colonies of microorganisms are visible; leukocyte infiltration and proliferation of local connective tissue and epithelial cells are almost completely absent. Large digestive glands belong to the category of organs insensitive to ionizing radiation, however, microscopic examination, for example, in the liver, reveals circulatory disorders and signs of dystrophy, and by the time of death - significant destructive changes with signs of microbial and viral invasion (see Hepatitis, radiation) .

In the cardiovascular system in acute L. b. deep changes are localized Ch. arr. in small vessels, which is important in the pathogenesis of hemorrhagic diathesis. Morfol, signs of increasing vascular permeability in the form of wall edema, some swelling and detachment of the endothelium, increasing perivascular edema and fiberization of the vascular walls are detected even before the occurrence of hemorrhages. During the height of L. b. Diapedetic hemorrhages, diffuse saturation of vessel walls with erythrocytes and the phenomenon of plasmorrhagia are visible. In the heart there are dystrophic changes in muscle fibers, hemorrhages under the endocardium, into the myocardium and especially under the epicardium.

In the lungs with acute L. b. changes associated with circulatory disorders and inf. complications, among which the so-called deserves special attention. agranulocytic pneumonia, accompanied by the loss of serous-fibrinous-hemorrhagic exudate, the formation of foci of necrosis with colonies of microorganisms without a perifocal inflammatory reaction.

In the kidneys in acute L. b. Ch. are observed. arr. circulatory disorders and high vascular permeability: hemorrhages are visible in their tissue, protein fluid with an admixture of erythrocytes accumulates in the lumens of the glomerular capsules, and dystrophic changes in the epithelium of the convoluted tubules are noted.

For acute L. b. characterized by a deep disturbance of the activity of the endocrine glands, which is initially assessed as a manifestation of enhanced function; Subsequently, relative normalization occurs, and during the height of the disease, signs of function and depletion of the glands are revealed. After radiation exposure in lethal doses, degranulation of chromophilic cells occurs in the pituitary gland; in the thyroid gland, the size of the follicles decreases, the follicular epithelium hypertrophies, vacuolization and resorption of the colloid are noted. In the adrenal cortex, a redistribution of fatty inclusions occurs; in the medulla, a decrease in the number and sometimes complete release of chromaffin inclusions from the cells is observed.

In loose connective tissue - dystrophic changes, cell breakdown, a sharp decrease in the number and a shift in the ratio of cellular forms in favor of mature ones, destruction of fibers and interstitial substance. In bone tissue - the phenomenon of resorption of bone substance.

Changes in the nervous system during acute L. b. in the form of reactive phenomena or destruction, develop in parallel with vascular disorders, are focal in nature and localized in nerve cells, fibers and endings.

At radiation doses of 1000-2000 rad, radiation damage to the small intestine dominates (intestinal form of acute L.): the mucous membrane is thinned, covered with a few, grossly altered epithelial cells, and in places the submucosa of the intestinal wall is exposed. These changes are caused by the death and cessation of fiziol, renewal of the intestinal epithelium in conditions of continued exfoliation of cells from the surface of the villi of the mucous membrane in accordance with the life cycle of the tissue. Similar changes in the intestinal wall can also develop with local irradiation of the abdominal area or even individual intestinal loops.

At a radiation dose of 2000 to 5000 rad, especially with uneven exposure, pronounced hemodynamic disturbances predominate, Ch. arr. in the intestines and liver, with a sharp overflow of blood into the capillaries, venous vessels and the appearance of hemorrhages. The mucous membrane of the small intestine looks moderately swollen, micronecrosis and discomplexation of the parenchyma are noted in the liver.

So-called nervous form of acute L. b. develops during irradiation in doses of St. 5000 rad. In this case, circulatory and liquor circulation disorders prevail in the brain with the development of cerebral edema.

Clinical picture

In a wedge, during acute L. b. (chief sample of the bone marrow form) four periods are distinguished: initial, or the period of the primary general reaction; hidden, or latent, period of visible wedge, well-being; period of height, or pronounced wedge, manifestations; recovery period.

The period of the primary general reaction lasts from several hours to 1-2 days, characterized by a predominance of neuroregulatory changes, Ch. arr. reflex (dyspeptic syndrome); redistribution changes in the composition of the blood (usually neutrophilic leukocytosis); disturbances in the activity of analyzing systems. Symptoms of the direct damaging effect of ionizing radiation on lymphoid tissue and bone marrow are detected: a decrease in the number of lymphocytes, death of young cellular elements, the occurrence of chromosomal aberrations in bone marrow cells and lymphocytes. Characteristic wedge symptoms in the initial period are nausea, vomiting, headache, fever, general weakness, erythema. During the period of the primary general reaction, against the background of developing general weakness and vasovegetative changes, increased drowsiness and lethargy appear, alternating with a state of euphoric excitement. In acute L. b. severe and extremely severe degrees occur Meningeal and cerebral symptoms with increasing stupefaction (from hypersomnia to stupor and coma), which during the recovery period can affect the structure of the emerging psychoneurological syndrome.

The latent period lasts, depending on the radiation dose, from 10-15 days to 4-5 weeks. and is characterized by a gradual increase in pathol, changes in the most affected organs (continued depletion of the bone marrow, suppression of spermatogenesis, development of changes in the small intestine and skin) with a necro-rum subsiding of general neuroregulatory disorders and, as a rule, satisfactory well-being of patients.

The transition to a period of pronounced wedge manifestations occurs at different times for individual tissue elements, which is associated with the duration of the cell cycle, as well as their unequal adaptation to the action of ionizing radiation. The leading pathogenetic mechanisms are: deep damage to the blood system and intestinal tissue, suppression of the immune system (see Radiation Immunology), the development of infectious complications and hemorrhagic manifestations, intoxication. The duration of the period of pronounced wedge manifestations does not exceed 2-3 weeks. By the end of this period, against the background of still pronounced cytopenia, the first signs of bone marrow regeneration appear. In this period of acute L., caused by ionizing radiation at a dose exceeding 250 rad, without treatment. activities, a fatal outcome is possible, the immediate causes of which are bone marrow syndrome with its inherent hemorrhagic manifestations and inf. complications.

During the recovery period, the general condition of patients noticeably improves, the temperature drops to normal levels, hemorrhagic manifestations disappear, necrotic masses are rejected and shallow erosions on the skin and mucous membranes heal; from 2-5 months the function of the sweat and sebaceous glands of the skin is normalized, and hair growth resumes. In general, the recovery period covers 3 months. and is characterized, especially in severe forms of L., by the fact that, along with regeneration in damaged organs, increased exhaustion and function, insufficiency of regulatory processes, especially in the cardiovascular and nervous systems, persist for a long time. Complete completion of recovery processes depending on the severity of L. b. may drag on for 1-3 years.

Decisive influence on the course of L. b. are influenced by the conditions of radiation exposure and the magnitude of the absorbed dose. So, with prolonged irradiation from several hours to 3-4 days. the primary reaction in the form of nausea, vomiting, weakness occurs later than with short-term (impulsive) exposure to the same dose, although no other differences in the course and severity of the disease are detected. With prolonged fractionated irradiation lasting more than 10 days. a clear cyclicity in the formation of the disease disappears, the primary reaction may be absent, the peak period is extended; The recovery period proceeds slowly. Patients develop a bone marrow form of L. b. with a subacute course of varying severity; the overall severity of the disease is lower than with simultaneous irradiation at the same dose. With uneven irradiation, the overall severity of the lesions decreases, the main patterns of the course of the disease (cyclicality, suppression of hematopoiesis) are revealed less clearly, and the symptoms of damage to the most irradiated organs and tissues come to the fore. With L., which occurs as a result of irradiation with a predominance of the neutron component, a slightly greater intensity of the primary reaction and early appearance of local radiation damage to the skin, subcutaneous tissue, and oral mucosa are possible; Characterized by a more frequent and earlier occurrence of yellow-kish. disorders. With combined gamma and beta irradiation, the wedge, the picture of the lesion consists of the symptoms of acute L., combined with beta lesions of open areas of the skin and beta epitheliitis of the intestine. The general primary reaction is accompanied by phenomena of irritation of the conjunctiva and upper respiratory tract; dyspeptic disorders are more pronounced. Skin lesions are less deep than with gamma irradiation and have a relatively favorable course. Typical long-term consequences of acute L. b. are radiation cataracts (see), in severe forms there may be leukocytopenia, thrombocytopenia, moderate general asthenia and autonomic dysfunction, focal neurol, symptoms. In some cases, there are disorders of the endocrine system - hypofunction of the gonads and thyroid gland. 6-10 years after a single irradiation, especially at doses exceeding 100 rads, some authors noted an increase in the number of cases of myeloid leukemia (see Leukemia).

Depending on the magnitude of the absorbed radiation doses, acute L. b. according to severity, they are divided into four degrees: I degree - mild (dose 100-200 rad); II degree - average (dose 200-400 rad); III degree - severe (dose 400-600 rad); IV degree - extremely severe (dose more than 600 rad). In acute L. b. Mild degrees: some patients may have no signs of a primary reaction, but the majority experience nausea a few hours after irradiation, and a single vomiting is possible. In acute L. b. of moderate severity, a pronounced primary reaction is noted, manifested by Ch. arr. vomiting, which ends within 1-3 hours and stops after 5-6 hours. after exposure. In acute L. b. severe vomiting occurs 30 minutes - 1 hour after irradiation and stops after 6 -12 hours; The primary reaction ends after 6-12 hours. With an extremely severe degree of L. b. the primary reaction begins early: vomiting occurs after 30 minutes. after irradiation, it is painful and indomitable. IV degree - an extremely severe degree of acute L. b. - depending on the dose level, it manifests itself in several wedges, forms: transitional, intestinal, toxic and nervous.

Transitional (between bone marrow and intestinal) form (600 - 1000 rad): the basis of its pathogenesis is depression of hematopoiesis, however, in the wedge, signs of intestinal damage occupy a significant place; the primary reaction lasts 3-4 days (possible development of erythema, loose stools), from the 6-8th day enterocolitis, enteritis, and fever can be detected. The general course of the disease is severe, recovery is possible only with timely treatment.

Intestinal form (1000-2000 rad): the primary reaction is severe and prolonged, the development of erythema, loose stools is observed; in the 1st week pronounced changes occur in the mucous membrane of the oral cavity and pharynx, the temperature is low-grade, stool returns to normal; a sharp deterioration in the condition occurs on the 6th - 8th day of the disease - fever (up to t° 40°), severe enteritis, dehydration, bleeding, inf. complications.

Toxemic form (2000-5000 rad): primary reaction, as in the intestinal form; immediately after exposure, a short-term collapsed state without loss of consciousness is possible; on the 3-4th day. severe intoxication, hemodynamic disturbances (weakness, arterial hypotension, tachycardia, oliguria, azotemia) develop, from 3-5 days - general cerebral and meningeal symptoms (cerebral edema).

Nervous form (with irradiation at a dose of over 5000 rad): immediately after irradiation, collapse with loss of consciousness is possible, after restoration of consciousness (in the absence of collapse - in the first minutes after exposure), debilitating vomiting and diarrhea with tenesmus occurs; subsequently, consciousness is impaired, signs of cerebral edema appear, arterial hypotension and anuria progress; death occurs on days 1-3. with symptoms of cerebral edema.

Severe and extremely severe forms of L. b. are complicated by local radiation injuries (see), which are also possible in acute L. b. less severe with selective re-irradiation of individual areas of the body. Local radiation injuries have a similar general phase progression, but their latent period is relatively shorter and they have a pronounced wedge. manifestations are observed in the first 7-14 days, i.e., at a time when the general signs of L. b. poorly expressed.

Treatment

The first action after receiving information about radiation exposure and its possible dose is to remove the affected person from the area of ​​exposure to ionizing radiation; in case of radioactive contamination - dignity. treatment, decontamination of the skin and visible mucous membranes, copious gastric lavage. To stop the primary reaction, antiemetics are used (diphenidol, etaperazine, atropine, aminazine, aeron); for prolonged indomitable vomiting and associated hypochloremia, 10% sodium chloride solution is administered intravenously, and if there is a threat of collapse and a decrease in blood pressure, rheopolyglucin or glucose in combination with mezatone or norepinephrine; for symptoms of vascular and heart failure, corglycon, strophanthin, and cordiamin are prescribed.

In the latent period L. b. The patient's regimen is gentle. Sedatives and tranquilizers are used. In acute L. b. in extremely severe cases, transplantation of allogeneic or syngeneic bone marrow, compatible according to the AB0 system, Rh factor and typed by HLA antigens under the control of the MLC test is indicated (see Bone marrow transplantation)] the number of bone marrow cells in the transplant should be at least 10-15 billion. Bone marrow transplantation can be effective in the range of total radiation doses of 600-1000 rad.

In acute L. b. II - III degrees, already in the latent period, it is necessary to strive to create an aseptic regime - dispersing patients, placing them in isolated boxed rooms equipped with bactericidal lamps, or sterile boxes (see Sterile room). Upon entering the ward, the staff puts on gauze respirators, an additional gown and shoes placed on a mat moistened with 1% chloramine solution. The air and objects in the ward are subject to systematic bacterial control.

Prevention of inf. complications begin on the 8-15th day, depending on the predicted severity of acute L. b. and at any time when the number of blood leukocytes decreases to 1000 in 1 μl of blood. For prophylactic purposes, use broad-spectrum bactericidal antibiotics (oxacillin, ampicillin) 0.5 g orally four times a day; ampicillin can be replaced with kanamycin, which is administered intramuscularly twice a day, 0.5 g in 3-4 ml of 0.25-0.5% novocaine solution or in isotonic sodium chloride solution. It is possible to use other antibacterial drugs, for example, long-acting sulfonamides, which are less appropriate for prophylactic purposes when deep cytopenia is predicted (less than 1000 leukocytes and less than 100-500 granulocytes in 1 μl of blood). Important measures to prevent inf. complications in patients with acute lymphadenopathy are careful oral care and hygiene. treatment of the skin with antiseptic solutions. For the administration of any drugs, the preferred intravenous route is using an indwelling catheter installed in the subclavian vein. Means that reduce patol, afferentation) from affected organs and tissues are indicated, especially with the development of local damage - intravenous administration of novocaine solution, as well as its use in the form of regional blockades. Bandages moistened with solutions of rivanol and furatsilin are applied to the affected areas of the skin. The affected areas are cooled using available means; blisters on the skin are preserved, reducing their tension by puncture.

During the height of acute L. b. bed rest with maximum isolation of the patient is necessary to prevent exogenous infection. In cases with severe radiation damage to the mucous membrane of the mouth and pharynx, it is advisable to prescribe nutrition through a nasal tube with a complete, specially processed food. The appearance of signs of infectious complications is an indication for the use of maximum therapeutic doses of bactericidal antibiotics, which are prescribed empirically even before the type of pathogen is determined. The effect is assessed by a decrease in temperature, wedge, signs of regression of the inflammation focus and improvement in the general condition of the patient over the next 48 hours; if the effect is positive, the drugs are continued to be administered in full dose until the blood picture normalizes. In the absence of obvious improvement, these antibiotics are replaced with ceporin (cephaloridine) at a dose of 3-6 g per day and gentamicin sulfate at 120-180 mg per day. For urgent indications, replacement is carried out without taking into account bacterial data, research, and another bactericidal antibiotic can be added. Antibiotics for the treatment of inf. complications are administered at intervals not exceeding 6 hours. After 7-8 days, if the symptoms of agranulocytosis persist or a new focus of inflammation appears, the drugs are changed. To prevent fungal infection, patients are prescribed nystatin. Systematic bacterial studies are carried out to identify microflora and determine its sensitivity to antibiotics.

The higher the level of leukocytes in the blood, the more justified is the use of bacteriostatic antibiotics and sulfonamides, and their parenteral administration can be replaced by oral administration. Cancellation of antibiotics is possible when wedge, signs of elimination of foci of infection and the level of granulocytes reaching above 2000 in 1 μl of blood. For severe staphylococcal lesions of the mucous membrane of the mouth and pharynx, for pneumonia and septicemia, the use of antistaphylococcal plasma or antistaphylococcal gamma globulin is indicated.

To combat hemorrhagic syndrome, agents are used that replenish platelet deficiency: native or freshly collected blood, platelet mass (see), as well as agents that enhance the coagulating properties of blood (aminocapronic acid, Ambien, dry plasma), affecting the permeability of the vascular wall ( askorutin). For bleeding from the nose and wound surfaces, local drugs are prescribed: hemostatic sponge, fibrin film (see Fibrin sponge, film), dry thrombin, etc.

With the development of anemia, transfusions are carried out, including direct, of single-group Rh-compatible blood (see Blood transfusion), red blood cell mass (see), a suspension of frozen and washed red blood cells. To combat toxemia, intravenous drip administration of an isotonic solution of sodium chloride, glucose, hemodez, rheopolyglucin and other liquids is used, sometimes in combination with diuretics - in the prediction and development of cerebral edema. With pronounced yellowish intestines. syndrome requires special nutrition (mashed beggar, enveloping agents), antispasmodics; in case of severe intestinal lesions, parenteral nutrition is indicated (see) using protein hydrolysates (see).

Swelling and increasing pain in areas that have undergone significant overirradiation are indications for the use of antienzyme drugs: contrical (trasylol) followed by infusion of hemodez, rheopolyglucin, neocompensan and diuretics. In this case, a favorable analgesic effect occurs immediately at the time of administration, and an anti-edematous effect occurs after a certain time. In addition, agents are used that improve microcirculation and metabolic processes: angina (parmidine), glivenol (tribenoside), solcoseryl. In case of tissue necrosis and especially the appearance of signs of severe intoxication and sepsis, supported by a local infectious-necrotic process, necrectomy is indicated (see). It is advisable to carry out amputation in the 5-6th week, i.e., when blood counts improve, and the volume of the operation should be reduced as much as possible. Subsequent reconstructive plastic surgeries are performed depending on the wedge, indications and prognosis in several stages upon completion of the recovery period.

During the recovery period with L. b. in order to stabilize hematopoiesis and c. function. n. With. small doses of anabolic steroids are used - methandrostenolone (Nerobol), retabolil, vitamins, ch. arr. group B; A diet enriched with protein foods and iron is recommended. The motor mode, under the control of general well-being and the reaction of the cardiovascular system, gradually expands. Rational psychotherapy and the correct orientation of the patient in his work and life prognosis are extremely important. The time for discharge from hospital in the absence of local lesions, as a rule, does not exceed 2-3 months. from the moment of irradiation, return to work in case of acute L. b. II - III degrees are possible in 4-6 months. After inpatient treatment, a stay in a general somatic sanatorium and subsequent dispensary observation are indicated.

Staged treatment

When nuclear weapons are used, a large number of people may be affected by gamma and neutron radiation. Moreover, depending on the degree of protection of people, irradiation can be uniform or uneven. Acute L. b. may also arise as a result of exposure of people located in areas contaminated with nuclear explosion products (NEP), where the severity of radiation damage is mainly determined by external gamma radiation, which during the period of radioactive fallout can be combined with contamination of the skin, mucous membranes and clothing PNEs, and in some cases with their penetration into the body (see Incorporation of radioactive substances).

Bibliography: Afrikova L. A. Acute radiation injury to the skin, M., 1975, bibliogr.; Baisogolov G. D. On the pathogenesis of changes in the blood system during chronic radiation exposure, Med. radiol., vol. 8, no. 12, p. 25, 1963, bibliogr.; Biological effects of uneven radiation exposure, ed. N. G. Darenskoy, p. 11, M., 1974; Bond V., F l i d n e r T. and A r s h a m b o D. Radiation death of mammals, trans. from English, M., 19v 1; B o r i s o v V. P. et al. Emergency care for acute radiation exposure, M., 1976; Vishnevsky A. A. and Shreiber M. I. Military field surgery, p. 60, M., 1975; Military field therapy, ed. N. S. Molchanov and E. V. Gembitsky, p. 84, L., 1973; Hemorrhagic syndrome of acute radiation sickness, ed. T.K. Dzharakyana, L., 1976, bibliogr.; Guskova A.K. and B i s o g o l o in G. D. Human radiation disease, M., 1971, bibliogr.; The effects of the atomic bomb in Japan, ed. E. Oterson and S. Warren, trans. from English, M., 1960; The effect of ionizing radiation on the human body, ed. E. P. Cronkite et al., trans. from English, M., 1960; Ivanov A. E. Pathological changes in the lungs during radiation sickness, M., 1961, bibliogr.; Ilyin L. A. Fundamentals of protecting the body from exposure to radioactive substances, p. 237, M., 1977; To r and e in with to and y N. A. Essays on the pathological anatomy of radiation sickness, M., 1957, bibliogr.; Litvinov N. N. Radiation damage to the skeletal system, M., 1964, bibliogr.; Multi-volume guide to pathological anatomy, ed. A. I. Strukova, vol. 8, book. 2, p. 17, M., 1962; First medical aid for radiation accidents, ed. G. Merle, trans. from German, M., 1975; Guide to medical issues of radiation protection, ed. A. I. Burnazyan, p. 149, M., 1975; Guide to the organization of medical support in case of mass casualties of the population, ed. A. I. Burnazyan, vol. 2, p. 55, M., 1971; Streltsov and V.N. and Moskalev Yu.I. Blastomogenic effect of ionizing radiation, M., 1964, bibliogr.; T about k and N I. B. Problems of radiation cytology, M., 1974, bibliogr.; Fliedner T. M. et al. Guide to radiation hematology, trans. from English, p. 62, M., 1974, bibliogr.; Diagnosis and treatment of acute radiation injury, Proceedings of a scientific meeting jointly sponsored by the International Atomic Energy Agency and the World Health Organization, Geneva, WHO, 1961; Histopathology of irradiation from external and internal sources, ed. by W. Bloom, N. Y. a. o., 1948.

A. K. Guskova; N. A. Kraevsky, B. I. Lebedev (pat. an.), E. V. Gembitsky (military), R. G. Golodets (psychiatrist).

Radiation sickness

What is Radiation sickness -

Radiation sickness is formed under the influence of radioactive radiation in the dose range of 1-10 Gy or more. Some changes observed during irradiation at doses of 0.1-1 Gy are regarded as preclinical stages of the disease. There are two main forms of radiation sickness, which form after general, relatively uniform irradiation, as well as with very narrowly localized irradiation of a certain segment of the body or organ. Combined and transitional forms are also noted.

Pathogenesis (what happens?) during Radiation sickness:

Radiation sickness is divided into acute (subacute) and chronic forms depending on the time distribution and absolute value of radiation exposure, which determine the dynamics of developing changes. The uniqueness of the mechanism of development of acute and chronic radiation sickness excludes the transition of one form to another. The conventional limit that delimits acute or chronic forms is the accumulation over a short period of time (from 1 hour to 1-3 days) of a total tissue dose equivalent to that from exposure to 1 Gy of external penetrating radiation.

The development of the leading clinical syndromes of acute radiation sickness depends on external radiation doses, which determine the variety of lesions observed. In addition, the type of radiation also plays an important role, each of which has certain characteristics, which are associated with differences in their damaging effect on organs and systems. Thus, a-radiation is characterized by a high ionization density and low penetrating ability, and therefore these sources cause a damaging effect limited in space.

Beta radiation, which has weak penetrating and ionizing ability, causes tissue damage directly in areas of the body adjacent to the radioactive source. On the contrary, y-radiation and x-rays cause deep damage to all tissues in the area of ​​their action. Neutron radiation causes significant heterogeneity in the damage to organs and tissues, since their penetrating ability, as well as linear energy losses along the path of the neutron beam in tissues, are different.

In the case of irradiation with a dosage of 50-100 Gy, damage to the central nervous system determines the leading role in the mechanism of development of the disease. With this form of the disease, death occurs, as a rule, on the 4-8th day after exposure to radiation.

When irradiated in doses from 10 to 50 Gy, symptoms of damage to the gastrointestinal tract with rejection of the small intestinal mucosa, leading to death within 2 weeks, come to the fore in the mechanism of development of the main manifestations of the radiation-induced clinical picture of the disease.

Under the influence of a lower dose of radiation (from 1 to 10 Gy), symptoms typical of acute radiation sickness are clearly visible, the main manifestation of which is hematological syndrome, accompanied by bleeding and all kinds of complications of an infectious nature.

Damage to the organs of the gastrointestinal tract, various structures of both the brain and spinal cord, as well as the hematopoietic organs is characteristic of exposure to the above doses of radiation. The severity of such changes and the speed of development of disorders depend on the quantitative parameters of exposure.

Symptoms of Radiation Sickness:

In the formation and development of the disease, the following phases are clearly distinguished: Phase I - primary general reaction; Phase II - apparent clinical well-being (skeletal, or latent, phase); Phase III - pronounced symptoms of the disease; Phase IV is the period of restoration of structure and function.

If acute radiation sickness occurs in a typical form, its clinical picture can be divided into four degrees of severity. Symptoms characteristic of each degree of acute radiation sickness are determined by the dose of radioactive radiation that the patient received:

1) mild degree occurs when irradiated at a dose of 1 to 2 Gy;

2) moderate severity - the radiation dose ranges from 2 to 4 Gy;

3) severe - the radiation dose ranges from 4 to 6 Gy;

4) extremely severe degree occurs when irradiated at a dose exceeding 6 Gy.

If the patient received a dose of radioactive radiation in a dose of less than 1 Gy, then we have to talk about the so-called radiation injury, which occurs without any obvious symptoms of the disease.

Severe disease is accompanied by recovery processes that last a long time over 1-2 years. In cases where any changes remain that become persistent, in the future we should talk about the consequences of acute radiation sickness, and not about the transition of the acute form of the disease to the chronic one.

Phase I of the primary general reaction is observed in all individuals when exposed to doses exceeding 2 Gy. The time it appears depends on the dose of penetrating radiation and is calculated in minutes and hours. Characteristic signs of a reaction include nausea, vomiting, a feeling of bitterness or dry mouth, weakness, fatigue, drowsiness, and headache.

Shock-like conditions may develop, accompanied by a decrease in blood pressure, loss of consciousness, possibly an increase in temperature, as well as diarrhea. These symptoms usually occur with radiation doses exceeding 10 Gy. Transient redness of the skin with a slightly bluish tint is detected only in areas of the body that have been irradiated at a dose exceeding 6-10 Gy.

Patients have some variability in pulse and blood pressure with a tendency to decrease, and are characterized by a uniform general decrease in muscle tone, trembling of the fingers, and decreased tendon reflexes. Changes

electroencephalograms indicate moderate diffuse inhibition of the cerebral cortex.

During the first days after irradiation, neutrophilic leukocytosis is observed in the peripheral blood with the absence of noticeable rejuvenation in the formula. Subsequently, over the next 3 days, the level of lymphocytes in the blood decreases in patients, this is associated with the death of these cells. The number of lymphocytes 48-72 hours after irradiation corresponds to the received radiation dose. The number of platelets, erythrocytes and hemoglobin in these periods after irradiation does not change against the background of myelokaryocytopenia.

A day later, the myelogram reveals an almost complete absence of such young forms as myeloblasts, erythroblasts, a decrease in the content of pronormoblasts, basophilic normoblasts, promyelocytes, and myelocytes.

In phase I of the disease, at radiation doses exceeding 3 Gy, some biochemical changes are detected: a decrease in serum albumin, an increase in blood glucose levels with a change in the sugar curve. In more severe cases, moderate transient bilirubinemia is detected, thereby indicating metabolic disorders in the liver, in particular a decrease in the absorption of amino acids and increased protein breakdown.

Phase II - the phase of imaginary clinical well-being, the so-called hidden, or latent phase, is noted after the disappearance of signs of the primary reaction 3-4 days after irradiation and lasts for 14-32 days. The well-being of patients during this period improves; only some lability in the pulse rate and blood pressure level remains. If the radiation dose exceeds 10 Gy, the first phase of acute radiation sickness directly passes into the third.

From the 12th to 17th day, in patients exposed to radiation at a dose exceeding 3 Gy, baldness is detected and progresses. During these periods, other skin lesions also appear, which are sometimes prognostically unfavorable and indicate a high dose of radiation.

In phase II, neurological symptoms become more pronounced (impaired movements, coordination, involuntary trembling of the eyeballs, organic movements, symptoms of mild pyramidal insufficiency, decreased reflexes). The EEG shows the appearance of slow waves and their synchronization with the pulse rhythm.

In the peripheral blood, by the 2-4th day of the disease, the number of leukocytes decreases to 4 H 109/l due to a decrease in the number of neutrophils (first decrease). Lymphocytopenia persists and progresses somewhat. Thrombocytopenia and reticulocytopenia appear on days 8-15. The number of red blood cells does not decrease significantly. By the end of phase II, a slowdown in blood clotting is detected, as well as a decrease in the stability of the vascular wall.

The myelogram reveals a decrease in the number of more immature and mature cells. Moreover, the content of the latter decreases in proportion to the time elapsed after irradiation. By the end of phase II, only mature neutrophils and single polychromatophilic normoblasts are found in the bone marrow.

The results of biochemical blood tests indicate a slight decrease in the albumin fraction of serum proteins, normalization of blood sugar and serum bilirubin levels.

In phase III, which occurs with pronounced clinical symptoms, the timing of onset and the degree of intensity of individual clinical syndromes depend on the dose of ionizing radiation; The duration of the phase ranges from 7 to 20 days.

Damage to the blood system is dominant in this phase of the disease. Along with this, immunosuppression, hemorrhagic syndrome, the development of infections and autointoxication occur.

By the end of the latent phase of the disease, the condition of the patients deteriorates significantly, resembling a septic state with characteristic symptoms: increasing general weakness, rapid pulse, fever, low blood pressure. Pronounced swelling and bleeding of the gums. In addition, the mucous membranes of the oral cavity and gastrointestinal tract are affected, which manifests itself in the appearance of a large number of necrotic ulcers. Ulcerative stomatitis occurs when irradiated in doses of more than 1 Gy on the oral mucosa and lasts about 1-1.5 months. The mucous membrane almost always recovers completely. With high doses of radiation, severe inflammation of the small intestine develops, characterized by diarrhea, fever, bloating and pain in the ileal region. At the beginning of the 2nd month of the disease, radiation inflammation of the stomach and esophagus may occur. Infections most often manifest themselves in the form of ulcerative-erosive sore throats and pneumonia. The leading role in their development is played by autoinfection, which acquires pathogenic significance against the background of a pronounced inhibition of hematopoiesis and suppression of the immunobiological reactivity of the body.

Hemorrhagic syndrome manifests itself in the form of hemorrhages, which can be localized in completely different places: the heart muscle, skin, mucous membrane of the respiratory and urinary tract, gastrointestinal tract, central nervous system, etc. The patient experiences heavy bleeding.

Neurological symptoms are a consequence of general intoxication, infection, and anemia. Increasing general lethargy, adynamia, darkening of consciousness, meningeal symptoms, increased tendon reflexes, and decreased muscle tone are noted. Usually, signs of increasing edema of the brain and its membranes are detected. Slow pathological waves appear on the EEG.

Diagnosis of Radiation Sickness:

The hemogram shows a second sharp decrease in the number of leukocytes due to neutrophils (preserved neutrophils with pathological granularity), lymphocytosis, plasmatization, thrombocytopenia, anemia, reticulocytopenia, and a significant increase in ESR.

The beginning of regeneration is confirmed by an increase in the number of leukocytes, the appearance of reticulocytes in the hemogram, as well as a sharp shift in the leukocyte formula to the left.

The bone marrow picture at lethal doses of radiation remains devastated throughout phase III of the disease. At lower doses, after a 7-12-day period of aplasia, blast elements appear in the myelogram, and then the number of cells of all generations increases. With moderate severity of the process, signs of hematopoietic repair are detected in the bone marrow from the first days of phase III against the background of a sharp decrease in the total number of myelokaryocytes.

Biochemical studies reveal hypoproteinemia, hypoalbuminemia, a slight increase in the level of residual nitrogen, and a decrease in the amount of blood chlorides.

Phase IV - the immediate recovery phase - begins with normalization

temperature, improvement of the general condition of patients.

If there has been a severe course of acute radiation sickness, patients will experience a long-term pastiness of the face and limbs. The remaining hair becomes dull, dry and brittle; new hair growth at the site of baldness resumes 3-4 months after irradiation.

Pulse and blood pressure normalize, sometimes moderate hypotension remains for a long time.

For some time, hand tremors, static incoordination, a tendency to increase tendon and periostenal reflexes, and some unstable focal neurological symptoms have been noted. The latter are regarded as a result of functional disorders of cerebral circulation, as well as neuronal exhaustion against the background of general asthenia.

There is a gradual recovery of peripheral blood parameters. The number of leukocytes and platelets increases and by the end of the 2nd month reaches the lower limit of normal. In the leukocyte formula there is a sharp shift to the left to promyelocytes and myeloblasts, the content of band forms reaches 15-25%. The number of monocytes is normalized. By the end of the 2-3rd month of the disease, reticulocytosis is detected.

Until the 5-6th week of the disease, anemia continues to increase with phenomena of anisocytosis of erythrocytes due to macroforms.

The myelogram reveals signs of pronounced restoration of hematopoietic cells: an increase in the total number of myelokaryocytes, the predominance of immature cells of erythro- and leukopoiesis over mature ones, the appearance of megakaryocytes, an increase in the number of cells in the mitotic phase. Biochemical parameters are normalized.

Characteristic long-term consequences of severe acute radiation sickness are the development of cataracts, moderate leuko-, neutro- and thrombocytopenia, persistent focal neurological symptoms, and sometimes endocrine changes.

V persons exposed to radiation, in the long term, leukemia develops 5-7 times
more often.

The mechanism of development of the observed changes in hematopoiesis at various stages of acute radiation sickness is associated with different radiosensitivity of individual cellular elements. Thus, blast forms and lymphocytes of all generations are highly radiosensitive. Promyelocytes, basophilic erythroblasts and immature monocytoid cells are relatively radiosensitive. Mature cells are highly radioresistant.

On the first day after total irradiation at a dose exceeding 1 Gy, massive death of lymphoid and blast cells occurs, and with an increase in the irradiation dose, more mature cellular elements of hematopoiesis occur.

At the same time, the massive death of immature cells does not affect the number of granulocytes and erythrocytes in peripheral blood. The only exceptions are lymphocytes, which themselves are highly radiosensitive. The neutrophilic leukocytosis that occurs is mainly redistributive in nature.

Simultaneously with interphase death, the mitotic activity of hematopoietic cells is suppressed while maintaining their ability to mature and enter the peripheral blood. As a result, myelokaryocytopenia develops.

Severe neutropenia in phase III of the disease is a reflection of the devastation of the bone marrow and the almost complete absence of all granulocytic elements in it.

At approximately the same time, a maximum decrease in the number of platelets in the peripheral blood is observed.

The number of red blood cells decreases even more slowly, since their lifespan is about 120 days. Even if the flow of red blood cells into the blood completely stops, their number will decrease daily by approximately 0.85%. Therefore, a decrease in the number of erythrocytes and Hb content is usually detected only in phase IV - the recovery phase, when the natural loss of erythrocytes is already significant and has not yet been compensated by newly formed ones.

Treatment of Radiation Sickness:

In case of irradiation at a dose of 2.5 Gy or higher, fatal outcomes are possible. A dose of 4 ± 1 Gy is approximately considered the average lethal dose for humans, although in cases of irradiation at a dose of 5-10 Gy, clinical recovery with proper and timely treatment is still possible. When irradiated at a dose of more than 6 Gy, the number of survivors is practically reduced to zero.

To establish the correct tactics for managing patients, as well as predicting acute radiation sickness in exposed patients, dosimetric measurements are carried out, which indirectly indicate the quantitative parameters of radioactive exposure on tissue.

The dose of ionizing radiation absorbed by the patient can be determined on the basis of chromosomal analysis of hematopoietic cells, determined in the first 2 days after irradiation. During this period, per 100 peripheral blood lymphocytes, chromosomal abnormalities amount to 22-45 fragments in the first degree of severity, 45-90 fragments in the second degree, 90-135 fragments in the third degree, and more than 135 fragments in the fourth, extremely severe degree of the disease.

In phase I of the disease, aeron is used to relieve nausea and prevent vomiting; in cases of repeated and indomitable vomiting, aminazine and atropine are prescribed. In case of dehydration, saline infusions are necessary.

In case of severe acute radiation sickness, during the first 2-3 days after irradiation, the doctor carries out detoxification therapy (for example, polyglucin). To combat collapse, well-known drugs are used - cardamine, mesaton, norepinephrine, as well as kinin inhibitors: trasylol or contrical.

Prevention and treatment of infectious complications

The system of measures aimed at preventing external and internal infections uses isolators of various types with a supply of sterile air, sterile medical materials, care items and food. The skin and visible mucous membranes are treated with antiseptics; non-absorbable antibiotics (gentamicin, kanamycin, neomycin, polymyxin-M, ristomycin) are used to suppress the activity of intestinal flora. At the same time, large doses of nystatin (5 million units or more) are prescribed orally. In cases where the level of leukocytes decreases below 1000 per 1 mm3, prophylactic use of antibiotics is advisable.

When treating infectious complications, large doses of intravenously administered broad-spectrum antibacterial drugs (gentamicin, ceporin, kanamycin, carbenicillin, oxacillin, methicillin, lincomycin) are prescribed. When a generalized fungal infection occurs, amphotericin B is used.

It is advisable to enhance antibacterial therapy with biological drugs of targeted action (antistaphylococcal plasma and γ-globulin, antipseudomonal plasma, hyperimmune plasma against Escherichia coli).

If no positive effect is observed within 2 days, the doctor changes antibiotics and then prescribes them taking into account the results of bacteriological cultures of blood, urine, feces, sputum, smears from the oral mucosa, as well as external local infectious foci, which are performed on the day of admission and beyond. -in one day. In cases of viral infection, acyclovir can be used with effect.

The fight against bleeding includes the use of general and local hemostatic agents. In many cases, agents that strengthen the vascular wall (dicinone, steroid hormones, ascorbic acid, rutin) and increase blood clotting (E-AKK, ​​fibrinogen) are recommended.

In the vast majority of cases, thrombocytopenic bleeding can be stopped by transfusion of an adequate amount of freshly prepared donor platelets obtained by thrombocytopenia. Platelet transfusions are indicated in cases of deep thrombocytopenia (less than 20 109/l), occurring with hemorrhages on the skin of the face, upper half of the body, in the fundus, with local visceral bleeding.

Anemic syndrome rarely develops in acute radiation sickness. Transfusions of red blood cells are prescribed only when the hemoglobin level decreases below 80 g/l.

Transfusions of freshly prepared red blood cells, washed or thawed red blood cells are used. In rare cases, there may be a need for individual selection not only for the ABO system and Rh factor, but also for other erythrocyte antigens (Kell, Duffy, Kidd).

Treatment of ulcerative-necrotic lesions of the mucous membranes of the gastrointestinal tract.

In the prevention of ulcerative-necrotic stomatitis, rinsing the mouth after meals (with a 2% soda solution or a 0.5% novocaine solution), as well as antiseptics (1% hydrogen peroxide, 1% solution 1) are important: 5000 furatsilin; 0.1% gramicidin, 10% water-alcohol emulsion of propolis, lysozyme). In cases of candidiasis, nystatin and levorin are used.

One of the severe complications of agranulocytosis and direct exposure to radiation is necrotizing enteropathy. The use of biseptol or antibiotics that sterilize the gastrointestinal tract helps reduce clinical manifestations or even prevent its development. If necrotic enteropathy occurs, the patient is prescribed complete fasting. In this case, only the intake of boiled water and drugs that relieve diarrhea (dermatol, bismuth, chalk) is allowed. In severe cases of diarrhea, parenteral nutrition is used.

Bone marrow transplantation

Allogeneic histocompatible bone marrow transplantation is indicated only in cases characterized by irreversible depression of hematopoiesis and profound suppression of immunological reactivity.

Consequently, this method has limited capabilities, since there are still no sufficiently effective measures to overcome tissue incompatibility reactions.

The selection of a bone marrow donor is made necessarily taking into account the transplant antigens of the HLA system. In this case, the principles established for allomyelotransplantation with preliminary immunosuppression of the recipient (use of methotrexate, irradiation of blood transfusion media) must be observed.

Special attention should be paid to general uniform radiation used as a pre-transplant immunosuppressive and antitumor agent in a total dose of 8-10 Gy. The observed changes differ in a certain pattern; the severity of individual symptoms varies from patient to patient.

The primary reaction that occurs after radiation exposure at a dose of more than 6 Gy is the appearance of nausea (vomiting), chills against a background of elevated temperature, a tendency to hypotension, a feeling of dryness of the mucous membranes of the nose and lips, and a bluish complexion, especially the lips and neck. The general irradiation procedure is carried out in a specially equipped irradiator under constant visual observation of the patient using television cameras in the conditions of two-way communication. If necessary, the number of breaks can be increased.

Other symptoms that naturally arise as a result of “therapeutic” full irradiation include inflammation of the parotid gland in the first hours after irradiation, redness of the skin, dryness and swelling of the mucous membranes of the nasal passages, pain in the eyeballs, and conjunctivitis.

The most serious complication is hematological syndrome. As a rule, this syndrome develops in the first 8 days after the patient receives a dose of radiation.

Which doctors should you contact if you have radiation sickness:

Hematologist

Therapist

Is something bothering you? Do you want to know more detailed information about Radiation sickness, its causes, symptoms, methods of treatment and prevention, the course of the disease and diet after it? Or do you need an inspection? You can make an appointment with a doctor– clinic Eurolab always at your service! The best doctors will examine you, study external signs and help you identify the disease by symptoms, advise you and provide the necessary assistance and make a diagnosis. you also can call a doctor at home. Clinic Eurolab open for you around the clock.

How to contact the clinic:
Phone number of our clinic in Kyiv: (+38 044) 206-20-00 (multi-channel). The clinic secretary will select a convenient day and time for you to visit the doctor. Our coordinates and directions are indicated. Look in more detail about all the clinic’s services on it.

(+38 044) 206-20-00

If you have previously performed any research, Be sure to take their results to a doctor for consultation. If the studies have not been performed, we will do everything necessary in our clinic or with our colleagues in other clinics.

You? It is necessary to take a very careful approach to your overall health. People don't pay enough attention symptoms of diseases and do not realize that these diseases can be life-threatening. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that, unfortunately, it is too late to treat them. Each disease has its own specific signs, characteristic external manifestations - the so-called symptoms of the disease. Identifying symptoms is the first step in diagnosing diseases in general. To do this, you just need to do it several times a year. be examined by a doctor, in order not only to prevent a terrible disease, but also to maintain a healthy spirit in the body and the organism as a whole.

If you want to ask a doctor a question, use the online consultation section, perhaps you will find answers to your questions there and read self care tips. If you are interested in reviews about clinics and doctors, try to find the information you need in the section. Also register on the medical portal Eurolab to keep abreast of the latest news and information updates on the site, which will be automatically sent to you by email.

Other diseases from the group Diseases of the blood, hematopoietic organs and certain disorders involving the immune mechanism:

20.10.2017

Ionizing radiation causes a number of changes in the body; doctors call this complex of symptoms radiation sickness. All signs of radiation sickness are distinguished depending on the type of radiation, its dosage and the location of the harmful source. Due to harmful radiation, processes begin to occur in the body that threaten the functioning of systems and organs.

Pathology is included in the list of diseases, because of it irreversible processes develop. The current level of medicine allows us to slow down destructive processes in the body, but not to cure a person. The severity of this disease depends on how much of the body was irradiated, for how long, and how exactly the human immune system responded.

Doctors distinguish between forms of pathology when the irradiation was general and local, and also distinguish between combined and transitional types of pathology. Due to penetrating radiation, oxidative processes begin in the cells of the body, as a result they die. Metabolism is seriously impaired.

The main impact of radiation falls on the gastrointestinal tract, nervous and circulatory systems, and spinal cord. When systems are disrupted, dysfunction occurs in the form of combined and isolated complications. A complex complication occurs with grade 3 damage. Such cases end fatally.

The pathology occurs in a chronic form; the doctor can determine what radiation sickness is in a specific form based on the magnitude and duration of exposure. Each form has a development mechanism, so the transition of the identified form to another is excluded.

Types of harmful radiation

In the development of pathology, an important role is assigned to a specific type of radiation; each has specific effects on different organs.

The main ones are listed:

• alpha radiation. It is characterized by high ionization, but low ability to penetrate deep into tissues. Sources of such radiation are limited in their damaging effects;
• beta radiation. Characterized by weak ionizing and penetrating ability. Usually it affects only those parts of the body to which the source of harmful radiation is closely adjacent;
• gamma and x-ray radiation. Such types of radiation are capable of affecting tissue to a significant depth in the source area;
• neutron radiation. It differs in its penetrating ability, which is why organs are affected heterogeneously by such irradiation.

If the radiation reaches 50-100 Gy, then the main manifestation of the disease will be damage to the central nervous system. You can live with such symptoms for 4-8 days.

With irradiation of 10-50 Gy, the gastrointestinal tract is more damaged, the intestinal mucosa is rejected and death occurs within 2 weeks.

With minor exposure (1-10 Gy), the symptoms of radiation sickness are manifested by bleeding and hematological syndromes, as well as infectious complications.

What causes radiation sickness?

Irradiation can be external or internal, depending on how the radiation enters the body - transdermally, with air, through the gastrointestinal tract, mucous membranes or in the form of injections. Low doses of radiation always affect a person, but pathology does not develop.
The disease is said to occur when the radiation dose is 1-10 Gy or more. Among those who risk learning about the pathology called radiation sickness, what it is and why it is dangerous, there are groups of people:

• those receiving low doses of radiation in medical institutions (X-ray staff and patients who must undergo examinations);
• who received a single dose of radiation during experiments, during man-made disasters, from the use of nuclear weapons, during the treatment of hematological diseases.

Signs of radiation exposure

When radiation sickness is suspected, symptoms appear depending on the dose of radiation and the severity of complications. Doctors distinguish 4 phases, each with its own symptoms:

• • The first phase occurs in people who have received radiation at a dosage of 2 Gy. The rate at which clinical signs appear depends on the dose and is measured in hours and minutes. Main symptoms: nausea and vomiting, dryness and bitterness in the mouth, increased fatigue and weakness, drowsiness and headaches. A state of shock is detected, in which the victim faints; an increase in temperature, a drop in pressure, and diarrhea may be detected. This clinical picture is typical for irradiation at a dosage of 10 Gy. Victims have red skin in those areas that were in contact with radiation. There will be a change in pulse, low blood pressure, trembling fingers. On the first day after irradiation, the number of lymphocytes in the blood drops - the cells die.

• The second phase is called sluggish. It begins after the first phase has passed - approximately 3 days after irradiation. The second stage lasts up to 30 days, during which the state of health returns to normal. If the radiation dosage is more than 10 Gy, then the second phase may be absent, and the pathology passes into the third. The second phase is characterized by skin lesions. This indicates an unfavorable course of the disease. Neurological symptoms manifest themselves - the whites of the eyes tremble, motor activity is impaired, and reflexes are reduced. By the end of the second stage, the vascular wall becomes weak, blood clotting slows down.
• The third stage is characterized by the clinical picture of the disease. The timing of its onset depends on the radiation dose. Phase 3 lasts 1-3 weeks. Become noticeable: damage to the circulatory system, decreased immunity, autointoxication. The phase begins with a serious deterioration in health, fever, increased heart rate and a drop in blood pressure. The gums bleed and the tissues swell. The mucous membranes of the gastrointestinal tract and mouth are affected, and ulcerations appear. If the radiation dose is low, the mucous membrane will recover over time. If the dose is high, the small intestine is damaged, which is characterized by bloating and diarrhea, and abdominal pain. Infectious sore throats and pneumonia occur, and the hematopoietic system is inhibited. The patient has hemorrhages on the skin, digestive organs, mucous membrane of the respiratory system, and ureters. The bleeding is quite severe. The neurological picture is manifested by weakness, confusion, and meningeal manifestations.
• In the fourth stage, the structures and functions of organs improve, bleeding disappears, lost hair begins to grow, and damaged skin heals. The body takes a long time to recover, more than 6 months. If the radiation dose was high, rehabilitation may take up to 2 years. If the last, fourth, phase is over, we can say that the person has recovered. Residual effects can manifest as pressure surges and complications in the form of neuroses, cataracts, and leukemia.

Variants of radiation sickness

Diseases are classified by type based on the duration of exposure to radiation and dose. If the body is exposed to radiation, they speak of an acute form of pathology. If the radiation is repeated in small doses, they speak of a chronic form.
Depending on the dosage of radiation received, the following forms of damage are distinguished:

• • less than 1 Gy – radiation injury with reversible damage;
  • from 1-2 to 6-10 Gy - a typical form, another name is bone marrow. Develops after short-term exposure to radiation. Mortality occurs in 50% of cases. Depending on the dosage, they are divided into 4 degrees - from mild to extremely severe;
  • 10-20 Gy – gastrointestinal form, resulting from short-term irradiation. Accompanied by fever, enteritis, septic and infectious complications;

• 20-80 Gy is a toxemic or vascular form that occurs from simultaneous irradiation. Accompanied by hemodynamic disturbances and severe intoxication;
• over 80 Gy – cerebral form, when death occurs within 1-3 days. The cause of death was cerebral edema.

The chronic course of pathology is characterized by 3 periods of development - in the first, a lesion is formed, in the second, the body is restored, in the third, complications and consequences arise. The first period lasts from 1 to 3 years, during which the clinical picture develops with varying severity of manifestations.

The second period begins when radiation stops affecting the body or the dosage is reduced. The third period is characterized by recovery, then partial recovery, and then stabilization of positive changes or progression.

Treatment of radiation sickness

Irradiation with a dosage of more than 2.5 Gy is fraught with death. From a dose of 4 Gy the condition is considered fatal. Timely and competent treatment of radiation sickness from exposure to a dose of 5-10 Gy still gives a chance for clinical recovery, but usually a person dies from a dose of 6 Gy.

When radiation sickness is established, treatment in the hospital is reduced to an aseptic regimen in the rooms designated for this. Symptomatic therapy and prevention of infections are also indicated. If fever and agranulocytosis are detected, antibacterial and antiviral drugs are prescribed.

The following drugs are used in treatment:

• Atropine, Aeron – stop nausea and vomiting;
• saline solution – against dehydration;
• Mezaton - for detoxification on the first day after irradiation;
• gamma globulin increases the effectiveness of anti-infective therapy;
• antiseptics for treating mucous membranes and skin;
• Kanamycin, Gentamicin and antibacterial drugs suppress the activity of intestinal flora;
• donor platelet mass, irradiated with a dose of 15 Gy, is administered to replace the deficiency in the victim. If necessary, red blood cell transfusions are prescribed;
• local and general hemostatic agents to combat bleeding;
• Rutin and vitamin C, hormones and other medications that strengthen the walls of blood vessels;
• Fibrinogen to increase blood clotting.

In the room where patients with radiation sickness are being treated, infections are prevented (both internal and external), sterile air is supplied, the same applies to food and materials.

In case of local damage to the mucous membranes, they are treated with mucolytics with bactericidal action. Lesions on the skin are treated with collagen films and special aerosols, dressings with tannins and antiseptic solutions. Dressings with Hydrocortisone ointment are shown. If ulcers and wounds do not heal, they are excised and plastic surgery is prescribed.

If the patient develops necrotizing enteropathy, antibacterial drugs and Biseptol are prescribed to sterilize the gastrointestinal tract. At this time, the patient is advised to fast. You can drink water and take anti-diarrhea medications. In severe cases, parenteral nutrition is prescribed.

If the radiation dosage was high, the victim has no contraindications, a suitable donor has been found, and bone marrow transplantation is indicated. The reason for the procedure is a disruption of the hematopoietic process and suppression of the immunological reaction.

Complications of radiation sickness

The patient's health condition can be predicted taking into account the degree of radiation exposure and the duration of the harmful effects on the body. Those patients who survive 12 weeks after radiation have a good chance. This period is considered critical.

Even from radiation that is not fatal, complications of varying severity develop. This will be a malignant neoplasm, hemoblastosis, the inability to have children. Long-term disorders can manifest themselves in offspring at the genetic level.

The victim's chronic infections worsen. The vitreous body and lens become cloudy, and vision is impaired. Dystrophic processes are revealed in the body. Contacting the clinic will give you the maximum chance to prevent the development of consequences.

Radiation sickness is considered a severe and dangerous pathology, which manifests itself as a complex of various symptoms. While doctors have not developed a treatment, treatment is aimed at maintaining the body and reducing negative manifestations.

Of primary importance in preventing such illness is exercising caution near potential sources of hazardous radiation.

Radiation sickness can occur due to exposure of the body to quantities significantly exceeding the limit values. The circumstances that provoke the development of the disease can be called: external irradiation of the body, its individual part.

In addition, the catalyzing factor in the development of the disease is internal irradiation, which is observed due to the ingress of radioactive substances.

The method of penetration can be very diverse: respiratory tract, contaminated food, water.

Once inside, they begin to “store” inside tissues and organs, and the body is filled with the most dangerous foci of regular radiation.

Signs of radiation sickness

Symptoms during irradiation can manifest themselves in diametrically opposite ways:

– cardinal disturbance of appetite, sleep, extremely violent excited state

– weakness of the body, “rolling” complete apathy towards everything, frequent diarrhea, vomiting.

The disease is actively manifested by significant changes (disturbances) in the normal functioning of the nervous and hormonal systems, observed in conjunction with damage to cells and tissues. Especially, the cells of the intestinal tissue and bone marrow are exposed to maximum danger during radiation. The body’s defenses weaken, which inevitably entails a list of very unpleasant consequences: infectious complications, poisoning, hemorrhages.

Forms of the disease

There are two key types of this disease: acute and chronic.

1. Regarding the acute form radiation sickness, then it actively manifests itself during the initial irradiation of the body. During the course of the disease, the small intestine is exposed to damaging radiation. Very characteristic indicators for this condition are diarrhea and high temperatures. In addition, the large intestine, stomach are in the danger zone, and in some situations, the liver comes under attack.

Of course, there are a number of other negative consequences for the body after irradiation. Areas of the skin that have been exposed to radiation experience burns, and radiation dermatitis is observed. The eyes are also in the zone of maximum risk - radiation cataracts, retinal damage - just a few of the possible consequences of radiation.

After a minimum period of time has passed, after the body has been exposed to radiation, accelerated “depletion” of the bone marrow is observed. The quantitative content in the blood decreases extremely greatly.

In the vast majority of those exposed, literally after 60 minutes nausea occurs and vomiting is possible.

The main primary symptoms for acute radiation disease of moderate severity are vomiting.

Their onset varies in the range of 60-120 m, and ends their effect after 6 hours.

Vomit in severe cases of the disease, it occurs almost instantly, literally in thirty minutes, and the interval of its possible completion ranges from 8-12 hours.

Vomiting brings severe suffering to the body, is extremely painful, and is very difficult to “tame.”

2. Speaking about the chronic form, they mean repeated exposure to ionizing radiation in small doses.

In addition to the total radiation dose received by the body, it is necessary to take into account the fact over what time interval the radiation dose was absorbed by the body. Symptoms for this type of disease are very diverse:

– severe fatigue

– lack of desire to work

– feeling of weakness, severe irritability

– inhibition of hematopoiesis, expressed by a sharp decrease in formed blood elements, possible occurrence of

– it happens that with a given symptomatic background, various tumors (leukemia) arise and develop further.

Causes of radiation sickness

Circumstances that can lead to radiation damage to the human body can be conditionally classified into emergency and general. Talking about the former is a topic for a separate article, although accidents, thank God, do not happen so often, but they still exist (Fukushima, Chernobyl). Speaking about general radiation, it means therapeutic radiological exposure, for example, during bone marrow transplants, treatment of all kinds.

In most cases, the chronic form of radiation sickness cannot be called a consequence of the acute phase of this disease. Basically, the risk group consists of employees of radiological services and X-ray laboratories.

Treatment of radiation sickness

Of course, the key, fundamental condition for treatment will be the final cessation of any contact of the patient with the source of ionizing radiation. If possible, using specialized drugs, they try to remove radioactive substances. I would like to note that this cleansing procedure, by which radioisotopes of heavy and rare earth metals are removed from the body, is relevant and can bring a positive effect only at the very early stages of the development of the disease.

In the chronic form of the disease, physiotherapy is prescribed. If there are vegetative-vascular problems that make themselves felt by dizziness, various symptoms, then this is a strong argument for using a galvanic collar, ultrasound, or massage during therapy.

The doctor also prescribes medications that have high general tonic and calming properties. During therapy, much attention is paid to B vitamins, since they are most actively involved in the production of hemoglobin and nucleoproteins. Vitamin therapy is carried out 2-3 times, with an intermediate interval of two weeks. Pine baths, showers, followed by rubbing are also useful.

1. Pre-grind the celandine completely, including the stem and leaves. Next, place the resulting mixture (200 g) in a gauze bag in advance and lower it to the bottom of a three-liter container. After filling the jar with 3 liters of whey, add sour cream (1 tsp). To completely prevent the occurrence of wine midges, it is strongly recommended to carefully cover the bottle with several (3-4) layers of gauze. For the full formation of strong lactic acid bacteria, this composition should be kept in a warm, dark place for three weeks.

Taking celandine enzymes for 10 days, 100 ml each, will significantly contribute to the restoration of the epithelial gastric surface, and indeed, completely. Radionuclides and various heavy metals are detached from the intestinal epithelial hairs.

2. Inhalation with celandine enzymes allows you to remove radionuclides from the lungs. To achieve this goal, you need to breathe over celandine vapors every day for ten minutes. After several days, dust particles containing radionuclides will be gradually removed from the lungs along with sputum.

3. The use of chestnut-based kvass, thirty minutes before meals, 200 ml, has proven extremely positive. This procedure will allow for a “drastic cleansing” of the body from radionuclides and heavy metals, at least from most of them. Cut 40 chestnut fruits in half. We fill them with a 3-liter container, previously filled with well water. After which, the following components should be added sequentially: sugar (200g), whey (100 ml), sour cream (20g). Kvass should be stored in a warm room (approximately thirty degrees), with a storage duration of two weeks.

Horse chestnut-based kvass significantly improves immunity and minimizes the chances of various diseases entering. Along the way, it grows stronger and the percentage of iodine and calcium increases. One more nuance needs to be taken into account. If you consume 200 ml of kvass from a container, then you should definitely add the same amount of water plus a couple of spoons of sugar. After 12 hours, the total volume of kvass will be the same.

4. An excellent remedy that can significantly cleanse the body of radionuclides is eggshells. The intake should be no more than 3 grams. Wash the eggs thoroughly with warm water and soap and then rinse well. After which, the shell should be boiled for five minutes. The best tool for bringing the shells to a powder state is a mortar. Depending on age, it is best to take it for breakfast, for example with cottage cheese or porridge.

5. Place flaxseed (200 g) in a container filled with two liters of very hot water. Place in a water bath and cook for two hours. After cooling, drink the decoction often in 100 ml doses.

6. The removal of radioactive substances from the stomach will be actively facilitated by the consumption of seaweed and steamed bran.

Nutrition for radiation sickness

The issue of well-planned nutrition is very important, since some foods, when ingested by the body, contribute to the elimination of certain types of radioactive substances. For example, magnesium salts (prunes, apples) can successfully combat “retained” strontium. White bread and cereals are consumed in extremely limited quantities.

– the daily protein component should be quite significant (minimum 140 g)

– for normalization, a nutritious diet must contain fermented milk products

– from fats, special preference should be given to those with a plant base.

When eating salads, adding a forest fern leaf will be very beneficial. Carrots, apples, and beets have a good binding effect against radionuclides.

Radiation sickness represents the final stage of a series of events that are actively developing due to the impact of large doses of radiation on the body. At the same time, molecular changes, the emergence of active elements in liquids and tissues, inevitably entail contamination of the blood with toxins, poisons, and most importantly, cells inevitably die.

Beware of this disease, take an interest in your health in a timely manner, goodbye.