Causes an acute form of radiation sickness. Radiation sickness: signs, symptoms and consequences

– a complex of general and local reactive changes caused by the effects of increased doses of ionizing radiation on cells, tissues and environments of the body. Radiation sickness occurs with symptoms of hemorrhagic diathesis, neurological symptoms, hemodynamic disorders, a tendency to infectious complications, gastrointestinal and skin lesions. Diagnosis is based on the results of radiation monitoring, characteristic changes in the hemogram, biochemical blood tests, and myelogram. In the acute stage of radiation sickness, detoxification, blood transfusions, antibiotic therapy, and symptomatic therapy are carried out.

The course of the typical (bone marrow) form of acute radiation sickness passes through phase IV:

I- phase of primary general reactivity - develops in the first minutes and hours after radiation exposure. Accompanied by malaise, nausea, vomiting, arterial hypotension, etc.
II- latent phase - the primary reaction is replaced by imaginary clinical well-being with an improvement in the subjective state. It starts from 3-4 days and lasts up to 1 month.
III- phase of advanced symptoms of radiation sickness; occurs with hemorrhagic, anemic, intestinal, infectious and other syndromes.
IV– recovery phase.

Chronic radiation sickness in its development goes through 3 periods: formation, recovery and consequences (outcomes, complications). The period of formation of pathological changes lasts 1-3 years. During this phase, a clinical syndrome characteristic of radiation injury develops, the severity of which can vary from mild to extremely severe. The recovery period usually begins 1-3 years after a significant reduction in intensity or complete cessation of radiation exposure. The outcome of chronic radiation sickness can be recovery, incomplete recovery, stabilization of the changes obtained, or their progression.

Symptoms of radiation sickness

Acute radiation sickness

In typical cases, radiation sickness occurs in the bone marrow form. In the first minutes and hours after receiving a high dose of radiation, in phase I of radiation sickness, the victim experiences weakness, drowsiness, nausea and vomiting, dry or bitter mouth, and headache. With simultaneous irradiation at a dose of more than 10 Gy, fever, diarrhea, arterial hypotension with loss of consciousness. Local manifestations may include transient cutaneous erythema with a bluish tint. From the outside peripheral blood early changes are characterized by reactive leukocytosis, which on the second day is replaced by leukopenia and lymphopenia. The myelogram determines the absence of young cell forms.

In the phase of apparent clinical well-being, the signs of the primary reaction disappear, and the victim’s well-being improves. However, objective diagnosis determines lability of blood pressure and pulse, decreased reflexes, impaired coordination, and the appearance of slow rhythms according to EEG data. 12-17 days after radiation injury, baldness begins and progresses. Leukopenia, thrombocytopenia, and reticulocytopenia increase in the blood. The second phase of acute radiation sickness can last from 2 to 4 weeks. With a radiation dose of more than 10 Gy, the first phase can immediately transition to the third.

In the phase of pronounced clinical symptoms of acute radiation sickness, intoxication, hemorrhagic, anemic, infectious, skin, intestinal, and neurological syndromes develop. With the onset of the third phase of radiation sickness, the victim’s condition worsens. At the same time, weakness, fever, and arterial hypotension increase again. Against the background of deep thrombocytopenia, hemorrhagic manifestations develop, including bleeding gums, nosebleeds, gastrointestinal bleeding, hemorrhages in the central nervous system, etc. The consequence of damage to the mucous membranes is the occurrence of necrotizing ulcerative gingivitis, stomatitis, pharyngitis, gastroenteritis. Infectious complications of radiation sickness most often include sore throats, pneumonia, and pulmonary abscesses.

Radiation dermatitis develops with high-dose radiation. In this case, primary erythema forms on the skin of the neck, elbows, axillary and groin areas, which is replaced by swelling of the skin with the formation of blisters. In favorable cases, radiation dermatitis resolves with the formation of pigmentation, scars and thickening of the subcutaneous tissue. When the vessels become interested, radiation ulcers, skin necrosis. Hair loss is widespread: epilation of hair on the head, chest, pubis, loss of eyelashes and eyebrows is noted. In acute radiation sickness, there is a profound inhibition of the function of the endocrine glands, mainly the thyroid gland, gonads, and adrenal glands. In the long-term period of radiation sickness, an increase in the development of thyroid cancer has been noted.

Damage to the gastrointestinal tract can occur in the form of radiation esophagitis, gastritis, enteritis, colitis, hepatitis. In this case, nausea, vomiting, pain in the various departments abdomen, diarrhea, tenesmus, blood in the stool, jaundice. The neurological syndrome accompanying the course of radiation sickness is manifested by increasing adynamia, meningeal symptoms, confusion, decreased muscle tone, increased tendon reflexes.

During the recovery phase, health gradually improves, and impaired functions are partially normalized, but for a long time, patients remain anemic and asthenovegetative syndrome. Complications and residual lesions of acute radiation sickness may include the development of cataracts, liver cirrhosis, infertility, neuroses, leukemia, malignant tumors various localizations.

Chronic radiation sickness

In the chronic form of radiation sickness, the pathological effects unfold more slowly. The leading ones are neurological, cardiovascular, endocrine, gastrointestinal, metabolic, and hematological disorders.

Mild chronic radiation sickness is characterized by nonspecific and functionally reversible changes. Patients feel weakness, decreased performance, headaches, sleep disturbances, and emotional instability. Among the constant signs are loss of appetite, dyspeptic syndrome, chronic gastritis with decreased secretion, biliary dyskinesia. Endocrine dysfunction with radiation sickness it is expressed in decreased libido, menstrual irregularities in women, impotence in men. Hematological changes are unstable and not pronounced. The current is mild the degree of chronic radiation sickness is favorable, recovery without consequences is possible.

At medium degree After radiation injury, more pronounced vegetative-vascular disorders and asthenic manifestations are observed. Dizziness, increased emotional lability and excitability, weakening of memory are noted, and attacks of loss of consciousness are possible. Trophic disorders are added: alopecia, dermatitis, nail deformities. Cardiovascular disorders presented by a stand arterial hypotension, paroxysmal tachycardia. Grade II severity of chronic radiation sickness is characterized by hemorrhagic phenomena: multiple petechiae and ecchymoses, recurrent nasal and gingival bleeding. Typical hematological changes are leukopenia, thrombocytopenia; in the bone marrow - hypoplasia of all hematopoietic germs. All changes are permanent.

A severe degree of radiation sickness is characterized by degenerative changes in tissues and organs that are not compensated by the regenerative capabilities of the body. Clinical symptoms are progressive; intoxication syndrome and infectious complications, including sepsis, are additionally added. There is severe asthenia, persistent headaches, insomnia, multiple hemorrhages and repeated bleeding, loosening and loss of teeth, ulcerative necrotic changes in the mucous membranes, and total baldness. Changes in peripheral blood, biochemical parameters, bone marrow are deeply expressed. In IV, the extremely severe degree of chronic radiation sickness, the progression of pathological changes occurs steadily and quickly, leading to inevitable death.

Diagnosis of radiation sickness

The development of radiation sickness can be assumed based on the picture of the primary reaction and the chronology of the development of clinical symptoms. Facilitates diagnostics by establishing the fact of radiation damage and dosimetric monitoring data.

The severity and stage of the lesion can be determined by changes in the peripheral blood picture. With radiation sickness, there is an increase in leukopenia, anemia, thrombocytopenia, reticulocytopenia, and an increase in ESR. When analyzing biochemical parameters in the blood, hypoproteinemia, hypoalbuminemia, and electrolyte disturbances are detected. The myelogram reveals signs of severe inhibition of hematopoiesis. With a favorable course of radiation sickness, the recovery phase begins reverse development hematological changes.

Other laboratory diagnostic data (microscopy of scrapings of skin and mucous ulcers, blood culture for sterility), instrumental studies (EEG, electrocardiography, ultrasound of organs) are of auxiliary importance abdominal cavity, pelvis, thyroid gland, etc.), consultations with highly specialized specialists (hematologist, neurologist, gastroenterologist, endocrinologist, etc.).

Treatment of radiation sickness

In case of acute radiation sickness, the patient is hospitalized in a sterile box, providing aseptic conditions and bed rest. Primary measures include PSO of wounds, decontamination (gastric lavage, enema, skin treatment), administration of antiemetics, and elimination of collapse. During internal irradiation, the administration of drugs that neutralize known radioactive substances is indicated. On the first day after the appearance of signs of radiation sickness, powerful detoxification therapy is carried out (infusions of saline, plasma-substituting and saline solutions), forced diuresis. In cases of necrotic enteropathy, fasting is prescribed, parenteral nutrition, treatment of the oral mucosa with antiseptics.

In order to combat hemorrhagic syndrome, blood transfusions of platelets and red blood cells are carried out. With the development of DIC syndrome, fresh frozen plasma is transfused. For prevention purposes infectious complications antibiotic therapy is prescribed. A severe form of radiation sickness accompanied by bone marrow aplasia is an indication for bone marrow transplantation. For chronic radiation sickness, therapy is mainly symptomatic.

Prognosis and prevention

The prognosis of radiation sickness is directly related to the massiveness of the received radiation dose and the time of the damaging effect. Patients who survive the critical period of 12 weeks after irradiation have a chance of a favorable prognosis. However, even with non-lethal radiation injury, victims may subsequently develop hemoblastoses, malignant neoplasms various localizations, and various genetic abnormalities are detected in the offspring.

In order to prevent radiation sickness, persons located in the radio radiation zone must use personal radiation protection and control equipment, radioprotective drugs that reduce the radiosensitivity of the body. Persons in contact with sources of ionizing radiation must undergo periodic medical examinations with mandatory hemogram monitoring.

A disease of the body, such as radiation sickness, can occur in people as a result of exposure to a large number of ionizing rays, which causes damage to cell structures in various forms. Today, such diseases are rare because they can develop after a single exposure to a high dose of radiation. Chronic disease can occur as a result of constant exposure to small amounts of radiation. With such irradiation, all body systems and internal organs are damaged. For this reason, the clinical picture of such a disease may always differ.

Radiation sickness

This disease develops after exposure to high radioactive radiation from 1 to 10 Gy and above. There are situations when radiation exposure is recorded at doses of 0.1 to 1 Gy. In such a situation, the body is in a preclinical stage. Radiation sickness can occur in two forms:

As a result of the overall relatively uniform exposure to radioactive radiation.
After receiving a localized dose of radiation to a specific part of the body or internal organ.

There is also the possibility of a combination and manifestation of a transitional form of the disease in question.

Typically, the acute or chronic form appears depending on the radiation load received. The peculiarities of the mechanism of transition of the disease into an acute or chronic form completely exclude a change in condition from one to another. It is known that the acute form always differs from the chronic form in the rate of receiving a radiation dose of 1 Gy.

A certain dosage of the received radiation causes a clinical syndrome of any form. The type of radiation can also have its own characteristics, since the nature of the damaging effect on the body can differ significantly. Radiation is characterized by an increased ionization density and low penetrating ability; therefore, the destructive effects of such radiation sources have certain volume limitations.

Beta radiation with a low penetrating effect causes tissue damage precisely at the points of contact with the radiation source. Y-radiation contributes to penetrating damage to the structure of body cells in the area of distribution. Neutron radiation may be heterogeneous in terms of its effect on cell structure, since its penetrating ability may also differ.

If you receive a radiation dose of 50-100 Gy, the nervous system will be damaged. This variant of the development of the disease will lead to death 4-8 days after irradiation.

If you gain 10-50 Gy of radiation, radiation sickness will manifest itself in the form of damage to the digestive system, resulting in rejection of the intestinal mucosa. Fatal outcome in such a situation it occurs within 2 weeks.

Under the influence of a lower dose from 1 to 10 Gy, symptoms characteristic of the acute form normally appear, the main symptom of which is considered hematological syndrome. This condition is accompanied by bleeding and various infectious diseases.

Read in more detail about the causes and degrees of radiation sickness in this article.

Acute form, its symptoms and signs

Most often, radiation sickness develops in the bone marrow form in several stages.

Let's consider the main symptoms characteristic of the first stage:

General weakness;
Vomit;
Migraine;
Drowsiness;
Feeling of bitterness and dryness in oral cavity.

When the radiation dosage is more than 10 Gy, the above symptoms may be accompanied by the following:

Diarrhea;
Arterial hypotension;
Fever;
Fainting state.

Against this background, the following may appear:

Unnatural redness of the skin.
Leukocytosis, turning into lymphopenia or leukopenia.

At the second stage, the overall clinical picture improves, but during diagnostics the following features can be observed:

Unstability of heartbeat and blood pressure;
Poor coordination of movements;
Deterioration of reflexes;
The EEG shows slow rhythms;
Baldness occurs 2 weeks after receiving a dose of radiation;
Leukopenia and other unnatural blood conditions may worsen.

In a situation where the dose of radiation received is 10 Gy, the first stage can immediately develop into the third.

The patient's condition at the third stage worsens significantly. In this case, the symptoms of the first stage can increase significantly. In addition to everything, you can observe the following processes:

Bleeding in the central nervous system;
Damage to the lining of organs in the gastrointestinal tract;
Blood from the nose;
Damage to the oral mucosa;
Skin necrosis;
Gastroenteritis;
Stomatitis and pharyngitis may also develop.

The body lacks protection against infections, so the following may occur:

Angina;
Pneumonia;
Abscess.

Dermatitis can develop in situations where the dose of radiation received is very high.

Symptoms of the chronic form

If the form is chronic, all symptoms may appear a little slower. The main ones include:

Neurological;
Complications at work endocrine system;
Metabolic disorders;
Problems with the digestive system;
Hematological disorders.

At mild degree reversible changes appear in the body:

General weakness;
Deterioration in performance;
Migraines;
Sleep problems;
Poor mental state;
Appetite worsens all the time;
Dyspeptic syndrome develops;
Gastritis with impaired secretion.

Endocrine system disorders manifest themselves as follows:

Libido worsens;
Men experience impotence;
In women it manifests itself as untimely menstruation.

Hematological abnormalities are unstable and do not have a specific severity.

The chronic form, to a mild degree, can proceed favorably and is amenable to complete cure without any consequences in the future.

The average degree is characterized by vegetative-vascular anomalies and various asthenic formations.

Doctors also note:

Dizziness;
Emotional instability;
Memory impairment;
Periodic loss of consciousness.

In addition to this, the following trophic disorders are observed:

Rotting nails;
Dermatitis;
Alopecia.

Sustained hypotension and tachycardia also develop.

Treatment of radiation sickness

After irradiation, it is necessary to provide the person with the following assistance:

Remove his clothes completely;
Wash in the shower as soon as possible;
Conduct an examination of the mouth, nose and mucous membranes of the eyes;
Next, it is necessary to perform a gastric lavage procedure and give the patient an antiemetic medication.

During treatment, it is necessary to carry out anti-shock therapy and give the patient the following medications:

Eliminating problems in the functioning of the cardiovascular system;
Promoting detoxification of the body;
Sedatives.

The patient needs to take a medicine that blocks gastrointestinal damage.

To cope with the first phase of radiation sickness, you need to use antiemetics. Aminazine and atropine are recommended to be used when vomiting cannot be stopped. A saline drip should be given to the patient if he or she becomes dehydrated.

If the patient is severely ill, it is imperative to detoxify within the first three days after receiving the radiation dose.

All kinds of isolators are used to prevent the development of infections. The following is supplied to specially equipped premises:

Clean air;
Necessary medications and devices;
Products for patient care.

Visible mucous membranes must be treated with antiseptics. The work of the intestinal microflora is blocked by antibiotics with the addition of nystatin.

With the help antibacterial agents manages to cope with the infection. Medicines biological type help fight bacteria. If the effect of antibiotics is not observed within two days, the medicine is replaced and the drug is prescribed taking into account the tests taken.

Consequences of the disease

The prognosis for the development of radiation sickness in each specific case depends on the dose of radiation received. On favorable outcome can be calculated if the patient manages to survive 12 weeks after receiving the radiation dose.

After nonfatal exposure to radiation, people are diagnosed with various complications, disorders, hemoblastosis, oncological processes. Loss of reproductive function often occurs, and genetic abnormalities are often observed in the children born.

Often aggravated infectious diseases develop into a chronic form, and all sorts of infections of blood cells occur. After receiving a dose of radiation, people may experience problems with vision, the lens of the eye becomes cloudy, and the appearance changes vitreous. So-called dystrophic processes can develop in the body.

To protect yourself as much as possible from possible diseases after radiation sickness, you need to contact specialized medical institutions. It must be remembered that radiation always hits the most weak points in the body.

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 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). Difficulty timely diagnosis and subsequent treatment consists of intensive processes of cellular renewal. Damaged tissue are restored, and the 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.

Radiation sickness with chronic course develops against the background:

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:

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.
Transitional. Develops after exposure to ionizing radiation at a dose of 6-10 Gy. Dangerous condition, sometimes ending in death.
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.
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.
Cerebral (fulminant, acute). The clinical picture is accompanied by loss of consciousness and sharp drop blood pressure after exposure to radiation 80-120 Gy. Lethal outcome is observed in the first 3 days, sometimes a person dies within a few hours.
Death under the beam. At doses of more than 120 Gy, a living organism dies instantly.

Chronic radiation disease is divided into 3 types:

Basic. External uniform exposure to radiation over a long period of time.
Heterogeneous. Includes both external and internal irradiation with a selective effect on certain organs and tissues.
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;
headaches;
pronounced blush;
drowsiness;
fatigue;
feeling of dryness.

Symptoms of more severe radiation exposure:

vomit;
fever;
diarrhea;
severe redness of the skin;
fainting;
severe 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:

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.
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 progress in the body. The disease can be diagnosed only by abnormalities in blood composition.
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.
Recovery. At permissible quantity 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 emerging 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 - first aid:

Completely undress the victim (the clothing is then disposed of).
Wash your body thoroughly in the shower.
Rinse your eyes, mouth and nasal cavity well with soda solution.
Rinse the stomach and intestines.
Give an antiemetic (Metoclopramide or any equivalent).

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:

Stop vomiting. Ondansetron, Metoclopramide, and the antipsychotic Chlorpromazine are prescribed. If you have an ulcer, platyphylline hydrotartrate or atropine sulfate are better options.
Detoxification. Droppers with physiological and glucose solutions and Dextran preparations are used.
Replacement therapy. Severe radiation sickness requires parenteral nutrition. For this purpose, fat emulsions and solutions with high content microelements, amino acids and vitamins - Intralipid, Lipofundin, Infezol, Aminol and others.
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.
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.
Activity Suppression intestinal microflora and fungi. In this case, antibiotics are also prescribed - Neomycin, Gentamicin, Ristomycin. To prevent candidiasis, Nystatin and Amphotericin B are used.
Virus therapy. Acyclovir is recommended as a preventive treatment.
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.
Restoring microcirculation and preventing the formation of blood clots. Heparins are used - Nadroparin, Enoxaparin and synonyms.
Relief of inflammatory processes. Maximum quick effect produces Prednisolone in small doses.
Prevention of collapse. Indicated, Niketamide, Phenylephrine, Sulfocamphocaine.
Improvement of neuroendocrine regulation. Novocaine is administered intravenously, B vitamins and calcium gluconate are additionally used.
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.
Local therapy for affected skin. Wet dressings with Rivanol, Linol, Furacilin are applied to the burned areas.
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;
physical therapy;
natural stimulants of the nervous system (schisandra, ginseng and others);
bromine preparations with caffeine;
B vitamins;
according to indications - tranquilizers.

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 high density ionization and low penetrating ability, and therefore these sources cause a spatially limited damaging effect.

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 come to the fore in the mechanism of development of the main manifestations of the radiation clinical picture of the disease gastrointestinal tract with rejection of the small intestinal mucosa, leading to death within 2 weeks.

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.

In the event that acute radiation sickness occurs in typical form, in its clinical picture four degrees of severity can be distinguished. 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, occurring 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 permanent, in the future we should talk about the consequences of acute radiation sickness, and not about the transition acute form diseases into chronic ones.

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 skin with a slightly bluish tint is detected only in areas of the body exposed to irradiation at a dose exceeding 6-10 Gy.

Patients have some variability in pulse and blood pressure with a tendency to decrease; they 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 disorders metabolic processes in the liver, in particular decreased 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 the 17th day, in patients exposed to radiation at a dose exceeding 3 Gy, baldness is detected and progresses. During these periods, other skin lesions, which are sometimes prognostically unfavorable and indicate a high dose of radiation.

In phase II, neurological symptoms become more distinct (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 × 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.

Results biochemical research blood 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, there is suppression of the immune system, hemorrhagic syndrome, development of infections and autointoxication.

By the end of the latent phase of the disease, the condition of the patients deteriorates significantly, resembling a septic condition 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 various places: 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 are noted, meningeal symptoms, increased tendon reflexes, decreased muscle tone. 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.

Bone marrow picture lethal doses irradiation remains devastated throughout the entire III phase 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, slight increase level of residual nitrogen, decrease in the amount of blood chlorides.

Phase IV - the immediate recovery phase - begins with normalization

temperatures, improvements general condition sick.

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 loss of coordination, a tendency to increase tendon and periostenal reflexes, and some unstable focal neurological symptoms have been noted. The latter are regarded as a result functional disorders 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 lower limit norms. 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 depletion of the bone marrow and almost complete absence it contains all granulocytic elements.

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, deaths. A dose of 4 ± 1 Gy is approximately considered average lethal for humans, although in cases of irradiation at a dose of 5-10 Gy, clinical recovery with proper and timely treatment 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). They are used well to combat collapse known remedies- 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, they are prescribed orally large doses nystatin (5 million units or more). 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 antibacterial drugs broad spectrum of action (gentamicin, ceporin, kanamycin, carbenicillin, oxacillin, methicillin, lincomycin). 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, antipseudomonas plasma, hyperimmune plasma against E. coli).

If it is not observed within 2 days positive effect, the doctor changes the antibiotics and then prescribes them based on the results bacteriological cultures blood, urine, feces, sputum, smears from the oral mucosa, as well as external local infectious foci, which are made on the day of admission and then every other day. In cases of accession viral infection Acyclovir can be used with effect.

The fight against bleeding includes the use of general and local action. 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 facial skin, upper half torso, on 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 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) is important, as well as antiseptics(1% hydrogen peroxide, 1% solution 1: 5000 furatsilin; 0.1% gramicidin, 10% water-alcohol emulsion of propolis, lysozyme). In cases of candidiasis, nystatin and levorin are used.

One of severe complications 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 preventing its development. If necrotic enteropathy occurs, the patient is prescribed complete fasting. In this case, only reception is allowed boiled water and drugs that relieve diarrhea (dermatol, bismuth, chalk). 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.

Therefore this method has limited opportunities, since there are still enough effective measures overcoming 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, sensations of dry mucous membranes of the nose and lips, and a bluish complexion, especially the lips and neck. Procedure general exposure is carried out in a specially equipped irradiator under constant visual observation of the patient using television cameras in conditions of two-way communication. If necessary, the number of breaks can be increased.

Among other symptoms that naturally arise as a result of “therapeutic” full irradiation, it should be noted inflammation 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, 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

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

B12 deficiency anemia

Anemia caused by impaired synthesis and utilization of porphyrins

Anemia caused by a violation of the structure of globin chains

Anemia characterized by the carriage of pathologically unstable hemoglobins

Fanconi anemia

Anemia associated with lead poisoning

Aplastic anemia

Autoimmune hemolytic anemia

Autoimmune hemolytic anemia with incomplete heat agglutinins

Autoimmune hemolytic anemia with complete cold agglutinins

Autoimmune hemolytic anemia with warm hemolysins

Heavy chain diseases

Werlhof's disease

von Willebrand disease

Di Guglielmo's disease

Christmas disease

Marchiafava-Miceli disease

Randu-Osler disease

Alpha heavy chain disease

Gamma heavy chain disease

Henoch-Schönlein disease

Extramedullary lesions

Hairy cell leukemia

Hemoblastoses

Hemolytic-uremic syndrome

Hemolytic anemia associated with vitamin E deficiency

Hemolytic anemia associated with glucose-6-phosphate dehydrogenase (G-6-PDH) deficiency

Hemolytic disease of the fetus and newborn

Hemolytic anemia associated with mechanical damage to red blood cells

Hemorrhagic disease of the newborn

Malignant histiocytosis

Histological classification of lymphogranulomatosis

DIC syndrome

Deficiency of K-vitamin-dependent factors

Factor I deficiency

Factor II deficiency

Factor V deficiency

Factor VII deficiency

Factor XI deficiency

Factor XII deficiency

Factor XIII deficiency

Iron deficiency anemia

Patterns of tumor progression

Immune hemolytic anemias

Bedbug origin of hemoblastoses

Leukopenia and agranulocytosis

Lymphosarcoma

Lymphocytoma of the skin (Caesary disease)

Lymphocytoma of the lymph node

Lymphocytoma of the spleen

March hemoglobinuria

Mastocytosis (mast cell leukemia)

Megakaryoblastic leukemia

The mechanism of inhibition of normal hematopoiesis in hemoblastoses

Obstructive jaundice

Myeloid sarcoma (chloroma, granulocytic sarcoma)

Myeloma

Myelofibrosis

Disorders of coagulation hemostasis

Radiation sickness occurs as a result of the damaging effects of ionizing radiation on the body. Its development can be associated both with external irradiation and with the ingress of radioactive substances into the body.

X-rays of alpha, beta, and gamma radiation, fluxes of fast or slow neutrons have penetrating ability. Gamma rays and neutrons have the greatest penetrating power. Beta particles and especially alpha particles have high ionizing power, but low penetrating power.

The biological effect of ionizing radiation depends on many factors: the type of radiation, the radiation dose, the size and location of the irradiated body surface, and the reactivity of the body. External irradiation with a dose of 600-700 roentgens of a large surface of the body is fatal. Less intense radiation causes the development of acute radiation sickness varying degrees gravity. Chronic radiation sickness can be the result of repeated external exposures, additional exposure to radioactive substances deposited in the body, or be a consequence of acute radiation sickness.

Symptoms of acute radiation sickness

Acute radiation sickness develops with a single total exposure to doses of ionizing radiation exceeding 100 rubles. Depending on the radiation dose, there are four stages of acute radiation sickness:

1st degree - mild, at doses of 100-200 roentgens;
2nd degree - moderate severity, at doses of 200-300 roentgens;
3rd degree - severe, at doses of 300-500 roentgens;
Stage 4 - extremely severe, with doses over 500 roentgens.

Acute radiation sickness- cyclical disease. During its course, four periods are distinguished: 1 - the period of the primary reaction, 2 - the latent period (period imaginary well-being), 3 - period of height (pronounced clinical events), 4 - resolution (recovery) period. Transitions from one period to another are usually gradual, their clinical picture depends on the dose of radiation received, the initial state of health of the victim, the size of the irradiated body surface, etc.

Primary reaction period begins either immediately after irradiation, or after 1-5 hours, which depends on the radiation dose, and lasts only from a few hours to 2 days. The disease begins with the development of a peculiar condition, which is expressed in irritability, agitation, headache, dizziness, and insomnia. Sometimes at the beginning of the disease there is lethargy and drowsiness. Disorders of appetite, nausea, thirst, and perversion of taste sensations are often observed. In severe cases of radiation sickness, uncontrollable vomiting occurs.

Autonomic disorders are manifested by cold sweat, vasomotor reactions and hyperemia (in severe cases - blanching) of the skin. Marked: tremor of closed eyelids, tongue, outstretched fingers, increased and uneven tendon and parietal reflexes. In extremely severe cases, meningeal symptoms are observed.

Tachycardia or bradycardia often occurs during this period. Sometimes violated heart rate. Over a short period of time, hypertension may develop, quickly followed by hypotension.

The development of destructive processes, a disorder of all types of metabolism, accompanied by the appearance of pyrogenic substances in the tissues and stimulation of the heat generation system, lead to an increase in body temperature, in severe cases up to 39°C.

Abdominal pain and gastrointestinal disorders may occur. A urine test can show the content of protein, sugar, and acetone in it. The content of residual blood nitrogen reaches upper limit norms. Hyperglycemia, a moderate increase in blood bilirubin, and changes in mineral metabolism are observed.

Latent period lasts from several days to 2-3 weeks. The shorter the period of imaginary well-being, the more severe the subsequent course of the disease. In acute radiation sickness of the 3rd and 4th degrees, the latent period may be absent. In the mildest cases, the disease ends with this period.

During this period, the patients’ well-being improves, excitement goes away, headaches disappear, sleep improves, and body temperature normalizes. The patient seems to be recovering. Only in severe cases do general weakness, dyspepsia and loss of appetite persist.

However, blood tests reveal further development diseases: the number of leukocytes begins to decrease, the number of lymphocytes continues to fall, the number of red blood cells decreases, their volume increases, and osmotic stability decreases. The number of reticulocytes and platelets decreases. When examining the bone marrow, inhibition of the red germ, accelerated maturation of myeloid cells, and a sharp predominance of the number of mature elements over young forms are noted.

High period lasts 2-4 weeks and is characterized by a pronounced deterioration in the general condition of the patient. Headache, dizziness, sleep disturbance, photophobia, meningeal symptoms, and pathological reflexes reappear. General weakness and apathy develop. Body temperature rises again to 39°C.

Hair loss begins in the second week after the lesion. The skin becomes dry and peels. In severe cases, erythema appears with the formation of blisters, subsequent decay and development of gangrene. Ulcers and necrosis occur on the mucous membrane of the mouth, tongue and respiratory tract.

Multiple hemorrhages are found on the skin and visible mucous membranes. Hemorrhages from internal organs - pulmonary, gastric, intestinal, kidney - become a severe manifestation of the disease.

When examining the cardiovascular system, toxic myocardial dystrophy is determined with its characteristic tachycardia, weakened sounds, decreased blood pressure, and disturbances in the rhythm of heart contractions. In the presence of hemorrhages in the heart muscle, a symptom complex characteristic of myocardial infarction develops.

Severe changes occur in the digestive system. The tongue is dry, covered with a brown or white coating, and sometimes it is smooth, “polished.” The severity of the disease is largely associated with the development of hemorrhagic gastritis and enterocolitis. Debilitating diarrhea contributes to the rapid exhaustion of patients. Ulcerative-necrotic changes in the gastrointestinal tract can lead to peritoneal complications.

The hematopoietic system undergoes profound changes. Inhibition of hematopoiesis progresses. The number of red blood cells and hemoglobin decreases, the diameter of red blood cells decreases, and their osmotic resistance continues to decrease. In severe cases of the disease, reticulocytes completely disappear from the peripheral blood. The number of leukocytes progressively decreases, the content of neutrophils decreases, and the number of lymphocytes decreases. With severe leukopenia, the number of lymphocytes may exceed the number of neutrophils; this is a poor prognostic sign. Eosinophils disappear from the peripheral blood, and the number of platelets decreases sharply. There are always pronounced qualitative changes in leukocytes. Bleeding time and blood clotting increases.

The height of radiation sickness is characterized by a decrease in the immune properties of the body. A decrease in the body's resistance, a violation of the integrity of the skin and mucous membranes are the cause of inflammatory complications (gingivitis, stomatitis, necrotizing tonsillitis, pneumonia, sepsis, etc.).

Resolution period occurs with a favorable course of the disease and lasts from 8 to 12 months, depending on the degree of exposure. The beginning of recovery is indicated, first of all, by the appearance of reticulocytes and young blood lymphocytes. Reticulocyte crises, eosinophilia, monocytosis are often observed, and red blood is restored. Gradually, in different sequences, the remaining symptoms of acute radiation sickness are smoothed out. However, asthenia, instability of reactions and their rapid depletion persist for a long time.

Possible consequences of radiation exposure in people who have suffered radiation sickness. The most important among them are: exacerbation of hidden chronic infections, blood diseases (leukemia, anemia, etc.), cataracts, vitreous opacities, general dystrophy, sexual dysfunction, various mutations in subsequent generations, tumors, etc.

Symptoms of chronic radiation sickness

As mentioned above, most often chronic radiation sickness is the result of repeated exposure of the body to small doses of external radiation or prolonged exposure to small amounts of radioactive substances that have entered the body. It may also be a consequence of acute radiation sickness.

Chronic radiation sickness is detected at various intervals after the onset of exposure to ionizing radiation on the body, which depends on the total dose of radiation and the reactivity of the body. Depending on the severity of symptoms, there are three degrees of chronic radiation sickness:

Chronic radiation sickness I degree- patients complain of irritability, sleep disturbances, decreased performance, or have no complaints at all. The examination reveals vegetative-vascular disorders - acrocyanosis, persistent dermographism, pulse lability, etc. Changes in the peripheral blood are insignificant: the number of leukocytes and platelets decreases slightly, moderate neutropenia and reticulocytopenia are sometimes observed. All these changes are easily reversible and quickly disappear when the patient is removed from the harmful environment.

Chronic radiation sickness II degree- dysfunction various organs and systems are more pronounced, persistent and generalized. Frequent complaints for headaches, fatigue, sleep problems, memory impairment. Damage to the nervous system at different levels leads to the development of diencephalic syndrome, solaritis, ganglionitis, and polyneuritis.

From the cardiovascular system, bradycardia, muffled heart sounds, and decreased blood pressure are observed. The permeability and fragility of blood vessels increases. The mucous membranes of the upper respiratory tract are atrophic and dry. Due to the development of persistent achylia, patients have decreased appetite and dyspeptic symptoms are observed. There are disturbances in enzymatic functions, especially pancreatic lipase and trypsin. Intestinal motility is impaired. The pituitary-adrenal system is damaged. People of both sexes often have decreased sexual feelings. Disorders of water, fat, carbohydrate and other types of metabolism are frequent. Dermatoses, peeling and hypotrophy of the skin, brittle nails, and hair loss appear. If there are radioactive substances incorporated in the bones in the body, pain occurs in the bones, especially in the legs. Warmth and rest usually intensify these pains.

The most characteristic feature persistent chronic radiation disease is a lesion hematopoietic system. The number of leukocytes decreases to 2000. Severe reticulocytopenia develops, blood clotting does not change. When examining the bone marrow, a decrease in the number of cellular elements, a pronounced delay in the maturation of myeloid elements, and a change in erythropoiesis of the megaloblastic type are detected.

Chronic radiation sickness III degree - symptoms are more pronounced; changes in the nervous system are mainly organic in nature. In the central nervous system they develop as toxic encephalitis or demyelinating encephalomyelitis. There are signs of funicular myelosis, gross changes in the reflex, motor and sensitive areas. A fairly common symptom is bleeding. Hemorrhages can become a source of inflammatory processes, the healing of which is characterized by extreme torpidity. As the disease progresses, the hemorrhagic syndrome becomes increasingly malignant, leading, in particular, to kidney damage. The phenomena of myocardial dystrophy and circulatory failure intensify. Blood pressure is kept at extremely low numbers. Endocrine disorders lead to symptoms of severe adrenal insufficiency.