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

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

The course of a typical (bone marrow) form of acute radiation sickness goes 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 an 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 extended symptoms of radiation sickness; proceeds 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. In 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 decrease in the intensity or complete cessation of radiation exposure. The outcome of chronic radiation sickness may be recovery, incomplete recovery, stabilization of the changes 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 the first phase of radiation sickness, the victim develops weakness, drowsiness, nausea and vomiting, dryness or bitterness in the mouth, and headache. With simultaneous exposure to a dose of more than 10 Gy, fever, diarrhea, arterial hypotension with loss of consciousness. Local manifestations may include transient skin erythema with a bluish tint. From the side peripheral blood early changes are characterized by reactive leukocytosis, which on the second day is replaced by leukopenia and lymphopenia. In the myelogram, the absence of young cell forms is determined.

In the phase of apparent clinical well-being, the signs of the primary reaction disappear, and the victim's well-being improves. However, with an objective diagnosis, the lability of blood pressure and pulse, a decrease in reflexes, impaired coordination, and the appearance of slow rhythms according to EEG are determined. Baldness begins and progresses 12-17 days after radiation injury. Leukopenia, thrombocytopenia, reticulocytopenia increase in the blood. The second phase of acute radiation sickness can last from 2 to 4 weeks. At an irradiation dose of more than 10 Gy, the first phase can immediately pass into the third.

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

With high-dose radiation, radiation dermatitis develops. In this case, primary erythema is formed on the skin of the neck, elbows, axillary and inguinal regions, which is replaced by skin edema with the formation of blisters. In favorable cases, radiation dermatitis resolves with the formation of pigmentation, scarring, and thickening of the subcutaneous tissue. When the vessels are interested, there are radiation ulcers, skin necrosis. Hair loss is common: there is epilation of hair on the head, chest, pubis, loss of eyelashes and eyebrows. In acute radiation sickness, there is a deep inhibition of the function of the endocrine glands, mainly the thyroid gland, gonads, and adrenal glands. In the late period of radiation sickness, an increase in the development of thyroid cancer was noted.

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

In the recovery phase, the state of health gradually improves, and impaired functions partially normalize, however, anemia and asthenovegetative syndrome persist for a long time in patients. Complications and residual lesions of acute radiation sickness may include the development of cataracts, liver cirrhosis, infertility, neurosis, leukemia, malignant tumors various localizations.

chronic radiation sickness

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

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

At medium degree radiation injury, more pronounced vegetative-vascular disorders and asthenic manifestations are noted. There are dizziness, increased emotional lability and excitability, weakening of memory, attacks of loss of consciousness are possible. Trophic disorders join: alopecia, dermatitis, nail deformities. Cardiovascular disorders represented by a rack arterial hypotension, paroxysmal tachycardia . For the II degree of severity of chronic radiation sickness, hemorrhagic phenomena are characteristic: multiple petechiae and ecchymosis, 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 dystrophic changes in tissues and organs that are not compensated by the regenerative capabilities of the body. Clinical symptoms are of progressive development, intoxication syndrome and infectious complications, including sepsis, are additionally added. There is a sharp asthenia, persistent headaches, insomnia, multiple hemorrhages and repeated bleeding, loosening and loss of teeth, ulcerative necrotic changes in mucous membranes, total alopecia. Changes in peripheral blood, biochemical parameters, bone marrow are deeply pronounced. With IV, an extremely severe degree of chronic radiation sickness, the progression of pathological changes occurs steadily and quickly, leading to an inevitable death.

Diagnosis of radiation sickness

The development of radiation sickness can be assumed on the basis of the picture of the primary reaction, the chronology of the development of clinical symptoms. Establishing the fact of radiation damaging effects and dosimetric monitoring data facilitates diagnosis.

The severity and staging of the lesion can be determined by changes in the pattern of peripheral blood. 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 revealed signs of severe hematopoiesis suppression. With a favorable course of radiation sickness in the recovery phase, reverse development hematological changes.

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

Radiation sickness treatment

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

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

Forecast and prevention

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

In order to prevent radiation sickness, persons in the zone of radio emission should 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 obligatory hemogram control.

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

Radiation sickness

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

1. As a result of the overall relatively uniform exposure to radioactive radiation.
2. 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.

Usually, the acute or chronic form manifests itself depending on the received radiation load. Features of the mechanism of the transition of the disease into an acute or chronic form completely excludes a change in state from one to another. It is known that the acute form always differs from the chronic form in the rate of receiving a dose of radiation in the amount of 1 Gy.

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

Beta radiation with a low penetrating effect causes damage to tissues precisely at the points of contact with the radiation source. U-radiation contributes to penetrating lesions of the body's cell structure in the distribution area. Neutron radiation can be non-uniform in terms of impact on the structure of cells, since the penetrating power can also differ.

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

If you gain radiation of 10-50 Gy, radiation sickness will manifest itself in the form of lesions of the digestive system, resulting in rejection of the intestinal mucosa. Death in this situation occurs in 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 a variety of infectious diseases.

Read more 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.

Consider the main symptoms characteristic of the first stage:

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

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

• Diarrhea;
• arterial hypotension;
• Fever;
• Fainting state.

Against this background, it may appear:

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

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

• Instability of heartbeat and blood pressure indicators;
• 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 received radiation is 10 Gy, the first stage can immediately develop into the third.

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

• Bleeding in the CNS;
• Damage to the lining of organs in the gastrointestinal tract;
• nosebleed;
• Damage to the oral mucosa;
• skin necrosis;
• Gastroenteritis;
• Stomatitis and pharyngitis may also develop.

The body lacks protection against infections, so it may occur:

• Angina;
• Pneumonia;
• Abscess.

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

Symptoms of the chronic form

If the chronic form occurs, all symptoms may appear a little more slowly. 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;
• Migraine;
• sleep problems;
• Poor mental state;
• Appetite worsens all the time;
• Dyspeptic syndrome develops;
• Gastritis with impaired secretion.

Violation of the endocrine system is manifested in this way:

• Libido worsens;
• Men have impotence;
• In women, it manifests itself as untimely menstruation.

Hematological anomalies are unstable and do not have a definite severity.

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

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.

Radiation sickness treatment

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

• Take off his clothes completely;
• Wash in the shower as soon as possible;
• Conduct an examination of the oral cavity, nose and mucous membranes of the eyes;
• Next, you need to perform a gastric lavage procedure and give the patient an antiemetic medicine.

During treatment, it is necessary to carry out the procedure of anti-shock therapy, give the patient medicines:

• Eliminating problems in the work of the cardiovascular system;
• Contributing to the detoxification of the body;
• Sedative drugs.

The patient needs to take a medication that blocks damage to the gastrointestinal tract.

To cope with the first phase of radiation sickness, you need to use antiemetics. Aminazine and atropine are recommended for use when vomiting cannot be stopped. A dropper with saline should be placed on the patient if he becomes dehydrated.

If the patient has a severe degree, it is imperative to detoxify within the first three days after receiving a dose of radiation.

All kinds of isolators are used to prevent the development of infections. In specially equipped rooms is served:

• Fresh air;
• Necessary medicines and devices;
• Patient care products.

Be sure to treat visible mucous membranes with antiseptics. The work of the intestinal microflora is blocked by antibiotics with the addition of nystatin.

With help antibacterial agents manages to fight off the infection. Medications biological type help fight bacteria. If within two days the effect of antibiotics is not observed, 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 a dose of radiation.

After irradiation without lethal outcome, people are diagnosed with various complications, disorders, hemoblastoses, oncological processes. Often there is a loss of reproductive function, and genetic abnormalities are often observed in children born.

Often exacerbated infectious diseases flow into a chronic form, there are all kinds of infections of blood cells. After receiving a dose of radiation, people may experience vision problems, the lens of the eye becomes cloudy, the appearance changes vitreous body. The 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 organism.

Modern people have a remote understanding of radiation and its consequences, because the last large-scale catastrophe 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 deadly.

What is radiation sickness?

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

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

Acute radiation sickness

This course of pathology occurs as a result of uniform exposure to a large amount 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 a short torment.

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 exposure are low, amount to 10-50 rad 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 in intensive processes of cell renewal. Damaged tissues are restored, and the symptoms remain invisible for a long time.

The characteristic signs of the described pathology occur 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;
• the use of total irradiation in oncology, hematology, rheumatology;
• use of nuclear weapons.

radiation sickness with chronic course develops against:

• frequent radiological or radionuclide studies in medicine;
• professional activities related to ionizing radiation;
• eating 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. Dangerous state sometimes ending in death.
3. Intestinal. Occurs when exposed to radiation 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, it corresponds to an ionization dose of 20-80 Gy. Death occurs in 4-7 days due to severe hemodynamic disorders.
5. Cerebral (lightning, acute). The clinical picture is accompanied by loss of consciousness and sharp drop blood pressure after exposure to radiation 80-120 Gy. A 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.

Radiation chronic illness is divided into 3 types:

1. Basic. External uniform exposure to radiation for a long 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 heavy - 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;
• pronounced redness of the skin;
• fainting;
• Strong headache;
• hypotension;
• fuzzy pulse;
• lack of coordination;
• convulsive twitching of the limbs;
• lack of appetite;
• bleeding;
• the formation of ulcers on the mucous membranes;
• hair loss;
• thinning, brittle nails;
• violations of the genital organs;
• respiratory 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 received radiation dose - the amount in Gy + 1. The main symptom of the primary reaction is considered acute, including 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 the radiation sickness has receded, but pathological changes progress in the body. Diagnosis of the disease is possible only by violations of the blood composition.
3. Razgar. 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. At allowable amount 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 degree of damage and the severity of the pathology. When receiving small doses of radiation, it comes down to stopping the symptoms of poisoning and cleansing the body of toxins. In severe cases, special therapy is needed to correct all the disorders that have arisen.

Radiation sickness - first aid

If a person has been exposed to radiation, a team of specialists should be called immediately. Before they arrive, you need to perform some manipulations.

Acute radiation sickness - first aid:

1. Completely undress the victim (clothing is then disposed of).
2. Thoroughly wash the body under the shower.
3. Rinse eyes, mouth and nose well with soda solution.
4. Rinse the stomach and intestines.
5. Give an antiemetic (Metoclopramide or any equivalent).

Acute radiation sickness - treatment

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

1. Cessation of vomiting. Ondansetron, Metoclopramide, neuroleptic Chlorpromazine are prescribed. In the presence of an ulcer, platyfillin hydrotartrate or atropine sulfate is better suited.
2. Detoxification. Droppers with physiological and glucose solution, Dextran preparations are used.
3. replacement therapy. Severe radiation sickness requires parenteral nutrition. For this, fat emulsions and solutions with high content trace elements, amino acids and vitamins - 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 shown daily transfusion of donor blood.
5. Treatment and prevention of infections. Strong ones are needed - Metillicin, Tseporin, Kanamycin and analogues. Biological-type preparations, for example, hyperimmune, anti-staphylococcal plasma, help to increase their effectiveness.
6. Activity suppression intestinal microflora and fungi. In this case, antibiotics are also prescribed - Neomycin, Gentamicin, Ristomycin. Nystatin, Amphotericin B is used to prevent candidiasis.
7. Virus therapy. Acyclovir is recommended as a preventive treatment.
8. Fighting bleeding. Improvement of blood clotting and strengthening of the vascular walls are provided by steroid hormones, Dicinon, Rutin, fibrinogen protein, E-ACC.
9. Restoration of microcirculation and prevention of blood clots. Heparins are used - Nadroparin, Enoxaparin and synonyms.
10. Relief of inflammatory processes. Maximum quick effect produces Prednisolone in small doses.
11. collapse prevention. Shown are Niketamide, Phenylephrine, Sulfocamphocaine.
12. Improvement of neuroendocrine regulation. Novocaine is administered intravenously, B vitamins, calcium gluconate are additionally used.
13. Antiseptic treatment of ulcers on mucous membranes. Rinsing with soda or novocaine solution, Furacilin, hydrogen peroxide, propolis emulsion and similar means are recommended.
14. Local therapy of the affected skin. Wet dressings with Rivanol, Linol, Furacilin are applied to the burned areas.
15. symptomatic treatment. Depending on the symptoms present, patients are prescribed sedatives, antihistamines and painkillers, tranquilizers.

Chronic radiation sickness - treatment

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

• fortified diet;
• physiotherapy;
• natural stimulants of the nervous system (schizandra, 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 and more. Some changes observed with 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 are formed after a general relatively uniform exposure, as well as with a very narrowly localized exposure 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 subdivided into acute (subacute) and chronic forms, depending on the time distribution and the absolute value of radiation exposure, which determine the dynamics of developing changes. The peculiarity of the mechanism of development of acute and chronic radiation sickness excludes the transition of one form to another. The conditional boundary, delimiting acute or chronic forms, is the accumulation over a short period (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 the doses of external radiation, which determine the variety of observed lesions. In addition, the type of radiation also plays an important role, each of which has certain features that are associated with differences in their damaging effect on organs and systems. So, for a-radiation are characteristic high density ionization and low penetrating power, in connection with which these sources cause a damaging effect limited in space.

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

In the case of irradiation with a dosage of 50-100 Gy, CNS damage determines the leading role in the mechanism of the development of the disease. With this form of the disease, death is usually noted on the 4-8th day after exposure to radiation.

When irradiated in doses from 10 to 50 Gy, the 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 mucous membrane of the small intestine, 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 seen, the main manifestation of which is the 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 organs of hematopoiesis, is characteristic of exposure to the above radiation doses. The severity of such changes and the speed of development of disorders depend on the quantitative parameters of exposure.

Radiation sickness symptoms:

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

In the event that acute radiation sickness occurs in typical form, four degrees of severity can be distinguished in its clinical picture. The symptoms characteristic of each of the degrees of acute radiation sickness are due to the dose of radioactive exposure that fell on this patient:

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

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

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

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

If the patient received a dose of radioactive irradiation at 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.

A severe degree of the disease is accompanied by recovery processes that take a long time for 1-2 years. In cases where there are any changes that acquire a persistent character, in the future one should talk about the consequences of acute radiation sickness, and not about the transition acute form disease into a chronic one.

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

Perhaps the development of shock-like conditions, accompanied by a decrease in blood pressure, loss of consciousness, possibly fever, and diarrhea. These symptoms usually occur at doses greater than 10 Gy. transient redness skin with a somewhat bluish tinge is detected only in areas of the body that have been irradiated at a dose exceeding 6-10 Gy.

In patients, there is some variability in pulse and blood pressure with a downward trend, a uniform general decrease in muscle tone, trembling of the fingers, and a decrease in tendon reflexes are characteristic. Changes

electroencephalograms indicate moderate diffuse inhibition of the cerebral cortex.

During the first day after irradiation, neutrophilic leukocytosis is observed in the peripheral blood with no noticeable rejuvenation in the formula. In the future, over the next 3 days, the level of lymphocytes in the blood decreases in patients, this is due to the death of these cells. The number of lymphocytes after 48-72 hours after irradiation corresponds to the received dose of radiation. The number of platelets, erythrocytes and hemoglobin in these periods after irradiation does not change against the background of myelokaryocytopenia.

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

In the first phase of the disease, at radiation doses exceeding 3 Gy, some biochemical changes are detected: a decrease in the content of serum albumins, an increase in the level of blood glucose with a change in the sugar curve. In more severe cases, moderate transient bilirubinemia is detected, thereby indicating violations metabolic processes 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 latent, or latent, phase, is observed after the disappearance of signs of the primary reaction 3-4 days after exposure and lasts for 14-32 days. The state of health of patients in this period improves, only some lability of the pulse rate and blood pressure remains. If the radiation dose exceeds 10 Gy, the first phase of acute radiation sickness passes directly into the third.

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

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

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 (the first decrease). The lymphocytopenia persists and progresses somewhat. Thrombocytopenia and reticulocytopenia are added to the 8-15th day. 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 shows 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 testify to a slight decrease in the albumin fraction of serum proteins, normalization of blood sugar and serum bilirubin levels.

In the III phase, proceeding with a 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.

Dominant in this phase of the disease is the defeat of the blood system. In addition, there is immune suppression, hemorrhagic syndrome, the development of infections and autointoxication.

By the end of the latent phase of the disease, the condition of patients worsens greatly, resembling a septic condition with characteristic symptoms: increasing general weakness, rapid pulse, fever, low blood pressure. Swelling and bleeding of the gums. In addition, the mucous membranes of the oral cavity and the gastrointestinal tract are affected, which is manifested in the appearance of a large number of necrotic ulcers. Ulcerative stomatitis occurs when irradiated in doses of more than 1 Gy to the oral mucosa and lasts about 1-1.5 months. The mucous membrane almost always recovers completely. At high doses of radiation, severe inflammation of the small intestine develops, characterized by diarrhea, fever, bloating, and tenderness in the iliac region. At the beginning of the 2nd month of illness, radiation inflammation of the stomach and esophagus may be added. Infections are most often manifested in the form of ulcerative erosive tonsillitis 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 organism.

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

Neurological symptoms are the result of general intoxication, infection, anemia. There is a growing general lethargy, adynamia, darkening of consciousness, meningeal symptoms, increased tendon reflexes, decreased muscle tone. Usually there are signs of increasing swelling of the brain and its membranes. Slow pathological waves appear on the EEG.

Diagnosis of radiation sickness:

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

The beginning of regeneration confirms 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 picture of the bone marrow lethal doses irradiation remains devastated throughout the 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 a moderate severity of the course of the process in the bone marrow from the first days of phase III, against the background of a sharp decrease in the total number of myelokaryocytes, signs of hematopoietic repair are found.

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

Phase IV - the phase of immediate recovery - begins with normalization

temperature, improvement general condition sick.

In the event that there was a severe course of acute radiation sickness, the pastosity of the face and limbs persists for a long time in patients. The remaining hair fades, becomes dry and brittle, the growth of new hair at the site of baldness resumes on the 3-4th month after irradiation.

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

For some time, hand trembling, static incoordination, a tendency to increase tendon and periosteal reflexes, and some unstable focal neurological symptoms have been noted. The latter are regarded as the result functional disorders cerebral circulation, as well as the exhaustion of neurons 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 bound norms. In the leukocyte formula, there is a sharp shift to the left to promyelocytes and myeloblasts, the content of stab 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 the phenomena of anisocytosis of erythrocytes due to macroforms.

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

Typical 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 the course 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, there is a massive death of lymphoid and blast cells, and with an increase in the irradiation dose, more mature cellular elements of hematopoiesis.

At the same time, the mass 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 of a redistributive 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 the III phase of the disease is a reflection of the devastation of the bone marrow and almost total absence it contains all granulocytic elements.

Approximately at the same time, there is a maximum decrease in the number of platelets in the peripheral blood.

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

Radiation sickness treatment:

In the case of irradiation at a dose of 2.5 Gy and above, deaths. A dose of 4 ± 1 Gy is tentatively 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 determine the correct tactics for managing patients, as well as predicting acute radiation sickness, dosimetric measurements are carried out for exposed patients, which indirectly indicate the quantitative parameters of radioactive effects on tissues.

The dose of ionizing radiation absorbed by the patient can be determined on the basis of a chromosomal analysis of hematopoietic cells, and is determined in the first 2 days after exposure. 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, and more than 135 fragments in the fourth, extremely severe degree of the disease.

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

In severe acute radiation sickness, during the first 2-3 days after exposure, the doctor conducts detoxification therapy (for example, polyglucin). Well used to combat collapse known means- cardiamin, mezaton, norepinephrine, as well as kinin inhibitors: trasylol or contrical.

Prevention and treatment of infectious complications

In the system of measures aimed at the prevention of external and internal infections, various types of isolators with sterile air supply, sterile medical materials, care items and food are used. 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 the intestinal flora. At the same time inside are appointed large doses nystatin (5 million units or more). In cases of a decrease in the level of leukocytes below 1000 in 1 mm3, it is advisable to use prophylactic antibiotics.

In the treatment of infectious complications, large doses of intravenously administered antibacterial drugs broad spectrum of action (gentamicin, tseporin, kanamycin, carbenicillin, oxacillin, methicillin, lincomycin). When joining a generalized fungal infection, amphotericin B is used.

It is advisable to strengthen antibacterial therapy with biological preparations of directed action (antistaphylococcal plasma and y-globulin, antipseudomonal plasma, hyperimmune plasma against Escherichia coli).

If within 2 days it is not noted positive effect, the doctor changes 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 produced on the day of admission and then every other day. In cases of accession viral infection with effect, acyclovir can be used.

The fight against bleeding includes the use of hemostatic agents 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-ACC, fibrinogen) are recommended.

In the vast majority of cases, thrombocytopenic bleeding can be stopped by transfusing 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 trunk, on the fundus, with local visceral bleeding.

Anemic syndrome in acute radiation sickness rarely develops. Red blood cell transfusions are prescribed only when the hemoglobin level drops below 80 g / l.

Transfusions of freshly prepared erythrocyte mass, washed or thawed erythrocytes are used. IN rare cases there may be a need for individual selection not only for the AB0 system and the 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 eating (with a 2% soda solution or 0.5% novocaine solution) is important, as well as antiseptics(1% hydrogen peroxide, 1% solution 1: 5000 furacilin; 0.1% gramicidin, 10% water-alcohol emulsion of propolis, lysozyme). In cases of development of candidiasis, nystatin, levorin are used.

One of severe complications agranulocytosis and direct exposure to radiation is necrotic enteropathy. The use of biseptol or antibiotics sterilizing the gastrointestinal tract helps to reduce clinical manifestations or even prevent its development. With the manifestation of necrotic enteropathy, the patient is prescribed complete fasting. It is only allowed to receive boiled water and remedies for diarrhea (dermatol, bismuth, chalk). In severe cases of diarrhea, parenteral nutrition is used.

Bone marrow transplant

Transplantation of allogeneic histocompatible bone marrow 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 not enough effective measures overcoming reactions of tissue incompatibility.

The selection of a bone marrow donor is made necessarily taking into account the transplantation 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 the general uniform irradiation used as a pre-transplantation immunosuppressive and antitumor agent in a total dose of 8-10 Gy. The observed changes differ in a certain pattern; in different patients, the severity of individual symptoms is not the same.

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

Of the other symptoms that naturally arise as a result of "therapeutic" total irradiation, inflammation should be noted. parotid gland in the first hours after irradiation, redness of the skin, dryness and swelling of the mucous membranes of the nasal passages, sensations of pain in the eyeballs, conjunctivitis.

The most formidable complication is the 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 individual disorders involving the immune mechanism:

B12 deficiency anemia

Anemia due to impaired synthesis by utilization of porphyrins

Anemia due to a violation of the structure of globin chains

Anemia characterized by the carriage of pathologically unstable hemoglobins

Anemia Fanconi

Anemia associated with lead poisoning

aplastic anemia

Autoimmune hemolytic 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-Micheli disease

Rendu-Osler disease

Alpha heavy chain disease

gamma heavy chain disease

Shenlein-Henoch disease

Extramedullary lesions

Hairy cell leukemia

Hemoblastoses

Hemolytic uremic syndrome

Hemolytic uremic syndrome

Hemolytic anemia associated with vitamin E deficiency

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

Hemolytic disease of the fetus and newborn

Hemolytic anemia associated with mechanical damage to red blood cells

Hemorrhagic disease of the newborn

Histiocytosis malignant

Histological classification of Hodgkin's disease

DIC

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

Lymphosarcomas

Lymphocytoma of the skin (Caesari disease)

Lymph node lymphocytoma

Lymphocytoma of the spleen

Marching hemoglobinuria

Mastocytosis (mast cell leukemia)

Megakaryoblastic leukemia

The mechanism of inhibition of normal hematopoiesis in hemoblastoses

Mechanical jaundice

Myeloid sarcoma (chloroma, granulocytic sarcoma)

multiple myeloma

Myelofibrosis

Violations of coagulation hemostasis

Radiation sickness occurs as a result of the damaging effect of ionizing radiation on the body. Its development can be associated both with irradiation from the outside, 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 power. Gamma rays and neutrons are the most penetrating. Beta particles and especially alpha particles have a high ionizing but low penetrating power.

The biological effect of ionizing radiation depends on many factors: the type of radiation, the dose of radiation, the size and location of the irradiated surface of the body, the reactivity of the body. External irradiation with a dose of 600-700 roentgens of a large body surface is fatal. Less intense exposure 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 total single exposure to doses of ionizing radiation exceeding 100 r. Depending on the radiation dose, four stages of acute radiation sickness are distinguished:

• 1 degree - mild, at doses of 100-200 roentgens;
• 2 degree - moderate, at doses of 200-300 x-rays;
• 3 degree - severe, at doses of 300-500 roentgens;
• Grade 4 - extremely severe, at doses above 500 roentgens.

Acute radiation sickness- cyclic disease. Four periods are distinguished in its course: 1 - the period of the primary reaction, 2 - the latent period (the period imaginary well-being), 3 - peak period (expressed 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, depending on the dose of radiation, 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, insomnia. Sometimes at the beginning of the disease there is lethargy, drowsiness. Often there is a violation of appetite, nausea, thirst, perversion of taste sensations. In a severe form of radiation sickness, indomitable vomiting occurs.

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

Often during this period, tachycardia or bradycardia occurs. Sometimes broken heartbeat. Within a short time, hypertension may develop, rapidly changing to hypotension.

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

Abdominal pain and gastrointestinal disturbances may occur. Urinalysis can show the content of protein, sugar, acetone in it. The content of residual nitrogen in the blood reaches upper bound norms. There is hyperglycemia, a moderate increase in blood bilirubin, shifts in mineral metabolism.

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

During this period, the state of health of patients improves, excitement passes, headaches disappear, sleep improves, body temperature normalizes. The patient appears to be recovering. Only in severe cases, 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 erythrocytes decreases, their volume increases, 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, a sharp predominance of the number of mature elements over young forms are noted.

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

In the second week after the defeat, hair loss begins. The skin becomes dry and flaky. In severe cases, erythema appears with the formation of blisters, followed by disintegration and the development of gangrene. Ulcers, necrosis occur on the mucous membrane of the oral cavity, tongue and respiratory tract.

Multiple hemorrhages are found on the skin and visible mucous membranes. A severe manifestation of the disease is hemorrhage from the internal organs - pulmonary, gastric, intestinal, renal.

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

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, enterocolitis. Exhausting 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. The inhibition of hematopoiesis progresses. The number of erythrocytes and hemoglobin decreases, the diameter of erythrocytes decreases, their osmotic resistance continues to fall. In a severe course of the disease, reticulocytes completely disappear from the peripheral blood. The number of leukocytes progressively decreases, the content of neutrophils falls, the number of lymphocytes decreases. With a pronounced leukopenia, the number of lymphocytes may exceed the number of neutrophils; this is a poor prognostic sign. Eosinophils disappear from the peripheral blood, the number of platelets sharply decreases. Pronounced qualitative changes in leukocytes are always noted. Increased bleeding time and blood clotting.

The peak period of radiation sickness is characterized by a decrease in the body's immune properties. 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, necrotic tonsillitis, pneumonia, sepsis, etc.).

Permission 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, red blood is restored. Gradually, in a different sequence, the remaining symptoms of acute radiation sickness are smoothed out. However, asthenization, instability of reactions and their rapid exhaustion persist for a long time.

Exposure effects may occur in people who have had radiation sickness. The most important among them are: exacerbation of latent chronic infections, blood diseases (leukemia, anemia, etc.), cataracts, clouding of the vitreous body, general dystrophy, sexual dysfunction, various mutations in the next generations, tumors, etc.

Symptoms of chronic radiation sickness

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

chronic radiation sickness It is detected at various time 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 disturbance, decreased performance or 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, 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- dysfunctions various bodies and systems are more pronounced, persistent and generalized. Frequent complaints headache, fatigue, sleep problems, memory impairment. Damage to the nervous system at different levels leads to the development of diencephalic syndrome, solaritis, ganglionitis, polyneuritis.

On the part of the cardiovascular system, bradycardia, deafness of heart tones, and a decrease in blood pressure are observed. Increased permeability and fragility of blood vessels. The mucous membranes of the upper respiratory tract are atrophic and dry. Due to the development of persistent achilia, patients have reduced appetite, dyspeptic symptoms are observed. There are violations of enzymatic functions, especially pancreatic lipase and trypsin. Impaired intestinal motility. The pituitary-adrenal system is damaged. In people of both sexes, sexual feeling is often reduced. Violations of water, fat, carbohydrate and other types of metabolism are frequent. Dermatoses, peeling and hypotrophy of the skin, brittle nails, hair loss appear. In the presence of radioactive substances incorporated in the bones in the body, pains in the bones, especially in the legs, occur. In warmth and rest, these pains usually increase.

by the most hallmark persistent chronic radiation sickness 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 according to the megaloblastic type are detected.

chronic radiation sickness III degree - the symptoms are more pronounced; changes in the nervous system are mostly 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 sensory areas. Bleeding is a fairly common symptom. Hemorrhages can become a source of inflammatory processes, the healing of which is extremely torpid. As the disease progresses, the hemorrhagic syndrome becomes increasingly malignant, leading, in particular, to kidney damage. The phenomena of myocardial dystrophy, circulatory failure are intensifying. Arterial pressure remains at extremely low levels. Endocrine disorders lead to severe adrenal insufficiency.