Symptoms in different forms of radiation sickness

Radiation injury may be associated with exposure to rays as a result of external influence, or with the penetration of radiation substances directly into the body. In this case, the symptoms of radiation sickness may vary - it depends on the type of rays, dosage, scale and location of the affected surface, as well as the initial state of the body.

External damage to a significant area of the body with a dose of 600 roentgens is considered lethal. If the damage is not so intense, then an acute form of radiation sickness occurs. The chronic form is a consequence of repeated external exposures, or additional damage with internal penetration of radiation substances.

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Chronic radiation sickness

Chronic course occurs with repeated exposure of a person to small doses of external radiation, or with prolonged exposure to small amounts of radiation components that have penetrated the body.

The chronic form is not detected immediately, as the symptoms of radiation sickness increase gradually. This course is also divided into several degrees of complexity.

• Stage I – characterized by irritability, insomnia, and decreased concentration. It happens that patients do not complain of anything at all. Medical examinations indicate the presence of vegetative-vascular disorders – these may be cyanosis of the extremities, instability of cardiac activity, etc. Blood tests show minor changes: a slight decrease in the level of leukocytes, moderate thrombocytopenia. Such signs are considered reversible, and gradually disappear on their own when the radiation exposure ceases.
• Stage II – characterized by functional disorders in the body, and these disorders are already more pronounced, stable and numerous. Patients complain of constant headaches, fatigue, sleep disorders, memory problems. The nervous system suffers: polyneuritis, encephalitis, and other similar lesions develop.

Cardiac activity is disrupted: the heart rhythm slows down, the tones are muffled, blood pressure decreases. The vessels become more permeable and brittle. The mucous membranes atrophy and become dehydrated. Digestive problems arise: appetite worsens, stomach upset, diarrhea, nausea attacks often occur, peristalsis is disrupted.

As a result of damage to the pituitary-adrenal system, patients experience decreased libido and impaired metabolism. Skin diseases develop, hair becomes brittle and falls out, nails crumble. Musculoskeletal pain may appear, especially at high ambient temperatures.

The hematopoietic function is deteriorating. The level of leukocytes and reticulocytes is significantly reduced. Blood coagulation is still normal.

• Stage III – the clinical picture becomes more vivid, organic lesions of the nervous system are observed. The disorders resemble the signs of intoxication encephalitis or myelitis. Bleeding of any localization often appears, with slow and difficult healing. Circulatory failure occurs, blood pressure remains low, the functions of the endocrine system are disrupted (in particular, the thyroid gland and adrenal glands suffer).

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Symptoms of various forms of radiation sickness

There are several forms of the disease, depending on which organ system is affected. The damage to a particular organ directly depends on the dose of radiation in radiation sickness.

• The intestinal form appears with a radiation dose of 10-20 Gy. At first, symptoms of acute poisoning, or radioactive enterocolitis, are observed. In addition, the temperature rises, muscles and bones ache, general weakness increases. Simultaneously with vomiting and diarrhea, symptoms of dehydration, asthenohypodynamia, cardiovascular disorders progress, attacks of agitation and stupor occur. The patient may die in 2-3 weeks from cardiac arrest.
• The toxemic form appears with a radiation dose of 20-80 Gy. This form is accompanied by intoxication-hypoxic encephalopathy, which develops due to a disorder of the cerebral dynamics of the cerebrospinal fluid and toxemia. Symptoms of radiation sickness consist of progressive signs of hypodynamic asthenic syndrome and cardiac insufficiency. Significant primary erythema, progressive decrease in blood pressure, collapse state, impaired or absent urination can be observed. After 2-3 days, the level of lymphocytes, leukocytes, and platelets drops sharply. If a comatose state develops, the victim may die in 4-8 days.
• The cerebral form develops with a radiation dose of more than 80-100 Gy. Neurons and blood vessels of the brain are damaged, with severe neurological symptoms forming. Immediately after radiation damage, vomiting appears with a transient loss of consciousness in 20-30 minutes. After 20-24 hours, the number of agranulocytes drops sharply and lymphocytes in the blood disappear completely. Subsequently, psychomotor agitation, disorientation, convulsive syndrome, respiratory dysfunction, collapse and coma are observed. A fatal outcome can occur from respiratory paralysis in the first three days.
• The cutaneous form is expressed as a burn shock condition and an acute form of burn intoxication with the probability of suppuration of damaged skin. The shock condition is formed as a result of severe irritation of skin receptors, destruction of blood vessels and skin cells, as a result of which tissue trophism and local metabolic processes are disrupted. Massive loss of fluid due to disruption of the vascular network leads to increased thickening of the blood and a decrease in blood pressure.

As a rule, with the cutaneous form, a fatal outcome can occur as a result of a violation of the skin's barrier protection.

• The bone marrow form occurs when receiving general irradiation in a dose of 1-6 Gy, with predominantly hematopoietic tissue affected. Increased permeability of the vessel walls, disorder of vascular tone regulation, hyperstimulation of the vomiting center are observed. Attacks of nausea and vomiting, diarrhea, headaches, weakness, hypodynamia, a drop in blood pressure are standard symptoms of radiation injury. Peripheral blood analysis indicates a reduced number of lymphocytes.
• Lightning form of irradiation also has its clinical features. A characteristic sign is the development of a collapse state with loss of consciousness and sudden decrease in blood pressure. Often the symptoms are indicated by a shock-like reaction with a pronounced drop in pressure, cerebral edema, and urinary disorders. Attacks of vomiting and nausea are constant and multiple. Symptoms of radiation sickness develop rapidly. This condition requires emergency medical care.
• Manifestations of radiation sickness in the oral cavity may occur after a single lesion by rays in a dose of more than 2 Gy. The surface becomes dry and rough. The mucous membrane is covered with pinpoint hemorrhages. The oral cavity becomes matte. Digestive system and cardiac disorders gradually join in.

Later, the mucous membrane in the mouth swells, ulcers and necrotic areas appear in the form of light spots. Symptoms develop gradually, over 2-3 months.

Degrees and syndromes of radiation sickness

Acute radiation sickness occurs with a systemic single radiation exposure with an ionizing dose of more than 100 roentgens. According to the number of damaging rays, 4 degrees of radiation sickness are distinguished, namely, the acute course of the disease:

• Stage I – light, with a dosage of 100 to 200 roentgens;
• II st. – average, with a dosage of 200 to 300 roentgens;
• Stage III – severe, with a dosage of 300 to 500 roentgens;
• Stage IV – very severe, dosage more than 500 roentgens.

The acute course of the disease is characterized by its cyclicity. The division into cycles determines the periods of radiation sickness - these are different time intervals, following one after another, with different symptoms, but with some characteristic features.

• During the primary reaction period, the first signs of radiation damage are observed. This can occur either a few minutes after the radiation or a few hours later, depending on the amount of damaging radiation. The period lasts from 1-3 hours to 48 hours. The disease manifests itself as general irritability, overexcitement, headaches, sleep disturbances, and dizziness. Less frequently, apathy and general weakness may be observed. Appetite disorders, dyspeptic disorders, nausea attacks, dry mouth, and taste changes are noted. If the radiation is significant, constant and uncontrollable vomiting occurs.

Disorders of the autonomic nervous system are expressed in cold sweating, reddening of the skin. Often there is trembling of the fingers, tongue, eyelids, increased tone of the tendons. The heartbeat slows down or quickens, the rhythm of cardiac activity may be disturbed. Blood pressure is unstable, temperature indicators can increase to 39 ° C.

The urinary and digestive systems also suffer: pain in the abdomen appears, protein, glucose, and acetone are found in the urine.

• The latent period of radiation sickness can last from 2-3 days to 15-20 days. It is believed that the shorter this period, the worse the prognosis. For example, with III-IV degree damage, this stage is often absent altogether. With a mild course, the latent period can end with the patient's recovery.

What is typical for the latent period: the patient's condition improves significantly, he noticeably calms down, sleep and temperature indicators return to normal. There is a premonition of a quick recovery. Only in severe cases may drowsiness, dyspepsia and appetite disorders persist.

However, blood tests taken during this period indicate further progression of the disease. The level of leukocytes, lymphocytes, erythrocytes, thrombocytes and reticulocytes decreases. Bone marrow function is suppressed.

• During the peak period, which can last 15-30 days, the patient's condition deteriorates sharply. Headache, insomnia, and apathy return. Temperature readings rise again.

From the second week after irradiation, hair loss, dryness and peeling of the skin are observed. Severe radiation sickness is accompanied by the development of erythema, vesicular dermatitis and gangrenous complications. The mucous membranes of the oral cavity are covered with ulcers and necrotic areas.

Numerous hemorrhages occur on the skin, and in cases of severe damage, bleeding occurs in the lungs, digestive system, and kidneys. The heart and vascular system suffer - intoxication myocardial dystrophy, hypotension, and arrhythmia occur. In case of hemorrhage into the myocardium, the symptoms resemble those of an acute infarction.

The lesion of the digestive tract is revealed by a dry tongue with a dark or gray coating (sometimes shiny, bright), signs of gastritis or colitis. Liquid frequent diarrhea, ulcers on the surface of the stomach and intestines can provoke dehydration, exhaustion of the patient.

The hematopoietic function is disrupted, hematopoiesis is suppressed. The amount of blood components decreases, their level drops. The duration of bleeding increases, blood clotting worsens.

The body's immune defenses decline, which leads to the development of inflammatory processes, such as sepsis, tonsillitis, pneumonia, oral cavity lesions, etc.

• When the resolution period begins, we can talk about a positive course of the disease. This period lasts longer than the others - about 8-12 months, which depends on the dose of radiation received. The blood picture is gradually restored, the symptoms are smoothed out.

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Consequences and complications of radiation sickness

It is quite possible that patients who have suffered from radiation sickness will experience consequences. The most severe of these are:

• exacerbation of latent chronic infectious diseases;
• blood pathologies (leukemia, anemia, etc.);
• cataract;
• vitreous opacity;
• dystrophic processes in the body;
• disorder of the functionality of the reproductive system;
• genetic abnormalities in subsequent generations;
• development of malignant neoplasms;
• fatal outcome.

In case of a small degree of damage, recovery occurs in about 2-3 months, however, even despite the stabilization of blood indices and relief of digestive disorders, consequences in the form of severe asthenia remain, which makes patients incapacitated for about six months. Complete rehabilitation in such patients is observed after many months, and sometimes years.

In mild cases, blood counts return to normal by the end of the second month.

Symptoms of radiation sickness and its further outcome depend on the severity of radiation damage, as well as on the timeliness of medical care. Therefore, if you suspect radiation exposure, you should definitely consult a doctor.

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