Materiały źródłowe

• #1 Mayo Clinic Health Library – Radiation sickness | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20377044

  Radiation sickness is damage to the body caused by a large dose of radiation often received over a short time. This is called acute radiation sickness. The amount of radiation absorbed by the body, called the absorbed dose, determines how bad the illness will be. […] The severity of radiation sickness symptoms depends on how much radiation you’ve absorbed. How much you absorb depends on the strength of the radiated energy, the time of your exposures, and the distance between you and the source of radiation. […] The first symptoms of treatable radiation sickness are usually nausea and vomiting. The amount of time between exposure and when these symptoms develop is a clue to how much radiation a person has absorbed. […] After the first round of symptoms, a person with radiation sickness may have a brief period with no noticeable illness, followed by the onset of new, more-serious symptoms.

• #1 Radiation Poisoning: Causes, Symptoms, and Prevention

  https://www.healthline.com/health/radiation-poisoning

  Radiation poisoning happens when you’re exposed to extremely high radiation levels, like those caused by a nuclear explosion. Early symptoms include nausea and vomiting. Later, it causes organ damage. […] Radiation poisoning develops in four stages: Prodromal stage: Symptoms such as vomiting, nausea, or diarrhea can appear within minutes to days after exposure. Latent stage: Your symptoms subside during the latent phase, and you generally look and feel healthy for hours to weeks. Manifest illness stage: Your symptoms develop again in the manifest illness stage. The symptoms depend on which of your organ systems is damaged. Recovery or death: Your recovery process can last several weeks to up to 2 years. Most people die if they don’t recover within several months. […] Symptoms of radiation poisoning often develop shortly after exposure and can include: nausea and vomiting, headache, dizziness, weakness, fatigue, bleeding, hair loss, swelling, itching, skin redness, other skin problems. […] Early symptoms of radiation poisoning such as nausea, vomiting, or headaches can start within minutes to days. Recovery from radiation poisoning can take from several weeks to 2 years. The chances of surviving radiation poisoning decrease with increasing doses of radiation.

• #1 Radiation Sickness – What You Need to Know

  https://www.drugs.com/cg/radiation-sickness.html

  Radiation sickness develops when a person is exposed to high doses of radiation. It is also known as radiation toxicity, or acute radiation syndrome. A syndrome is a group of signs and symptoms that often happen together. […] The prodromal stage occurs within minutes to days after exposure. Symptoms may last, off and on, from minutes to several days. […] In the prodromal stage, you may have loss of appetite, nausea, and vomiting that comes and goes. This stage starts 1 hour to 2 days after exposure. […] In the prodromal stage, you may have loss of appetite, severe nausea, and vomiting that comes and goes. You may also have severe cramps and liquid diarrhea. […] In the prodromal stage, you may have severe nervousness and confusion. Severe nausea, vomiting, and watery diarrhea may come and go. You may also lose consciousness. This stage starts within minutes of exposure and can last for minutes to hours.

• #1 Health Library

  https://www.limamemorial.org/m/health-library/HIE%20Multimedia-TextOnly/1/000026

  Radiation sickness is illness and symptoms resulting from excessive exposure to ionizing radiation. […] Radiation sickness results when humans (or other animals) are exposed to very large doses of ionizing radiation. […] Radiation sickness is generally associated with acute exposure and has a characteristic set of symptoms that appear in an orderly fashion. […] The severity of symptoms and illness (acute radiation sickness) depends on the type and amount of radiation, how long you were exposed, and which part of the body was exposed. Symptoms of radiation sickness may occur right after exposure, or over the next few days, weeks, or months. […] Symptoms of radiation sickness may include: Weakness, fatigue, fainting, confusion; Bleeding from the nose, mouth, gums, and rectum; Bruising, skin burns, open sores on the skin, sloughing of skin; Dehydration; Diarrhea, bloody stool; Fever; Hair loss; Inflammation of exposed areas (redness, tenderness, swelling, bleeding); Nausea and vomiting, including vomiting of blood; Ulcers (sores) in the mouth, esophagus (food pipe), stomach or intestines.

• #1 Acute Radiation Syndrome: Symptoms, Treatment, and Recovery

  https://www.healthline.com/health/acute-radiation-syndrome

  Acute radiation syndrome (ARS) is a serious illness resulting from exposure to high amounts of radiation in a very short period. […] Although many movie and television accounts of ARS are dramatized, ARS is a real illness. It causes a range of severe symptoms and can be fatal if the exposure is high enough. […] In general, ARS symptoms include nausea, vomiting, weakness, and headaches, which can last for days, weeks, or months. Exposure to a very large amount of radiation can be fatal. […] Although the symptoms may be similar in all cases of ARS, the subtype may determine the specific symptoms and their severity. […] The symptoms of this subtype may include: nausea, vomiting, loss of appetite, fever, general feeling of being unwell, muscle pain. […] If you have gastrointestinal ARS, you might experience all of the symptoms of bone marrow ARS alongside: severe cramps, dehydration, severe diarrhea.

• #1 Acute Radiation Syndrome: Information for Clinicians | Radiation Emergencies | CDC

  https://www.cdc.gov/radiation-emergencies/hcp/clinical-guidance/ars.html

  Symptoms are extreme nervousness and confusion; severe nausea, vomiting, and watery diarrhea; loss of consciousness; and burning sensations of the skin. Onset occurs within minutes of exposure. Stage lasts for minutes to hours. […] If a patient received more than 0.05 Gy (5 rads) and three or four CBCs are taken within 8 to 12 hours of the exposure, a quick estimate of the dose can be made. […] Treat vomiting, and repeat CBC analysis, with special attention to the lymphocyte count, every 2 to 3 hours for the first 8 to 12 hours following exposure (and every 4 to 6 hours for the following 2 or 3 days). Sequential changes in absolute lymphocyte counts over time are demonstrated below in the Andrews Lymphocyte Nomogram. […] If no radiation exposure is initially suspected, you may consider ARS in the differential diagnosis if a history exists of nausea and vomiting that is unexplained by other causes.

• #1 Radiation Sickness (Acute Radiation Syndrome)

  https://my.clevelandclinic.org/health/diseases/24328-radiation-sickness

  Radiation sickness can cause a range of symptoms at first, which include feeling weak, confused, feverish and sick to your stomach. […] Symptoms may begin right after exposure or over the next few days, weeks or months. While symptoms vary based on the syndrome type, the first signs and symptoms of radiation sickness include: Weakness or fatigue. Nausea and vomiting. Vomiting blood. Rectal bleeding (bloody stools). Diarrhea. Fever. Confusion. Hair loss. Tenderness, discoloration, swelling or a burning sensation in your skin. […] Later, symptoms and complications unfold in stages related to the three ARS syndromes. […] Each acute radiation syndrome (ARS) has distinct stages. They are the: Prodromal stage: Initial symptoms start minutes to two days after exposure. Latent asymptomatic stage: A period with no symptoms begins hours to 21 days after exposure. Systemic illness stage: More severe symptoms and changes in your body start hours to fewer than 60 days after exposure. Symptoms vary based on the type of syndrome.

• #1 Radiation Sickness | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688608/all/Radiation_Sickness?q=Vomiting

  Radiation sickness, or acute radiation syndrome (ARS), is defined as an acute illness caused by radiation of most or all of the body with a relatively high dose of radiation over a short period of time. […] Four major stages in ARS: prodrome, latent phase, illness, and either recovery or death. The higher the radiation doses, the shorter and more severe each stage: […] The prodrome appears within minutes to 4 days of postexposure, lasts between a few hours and a few days, and can include nausea and vomiting. […] Latent phase lasts from hours to several weeks when an individual feels quite well. […] Illness phase usually starts from 1st day to the 2nd week with an abrupt onset. […] Recovery phase may take weeks to more than a month. […] Time within and progression through these stages is dependent in part on access to, and availability of, treatment and, in part, on total dose received.

• #1 Radiation sickness: 8 terrifying symptoms

  https://www.cbsnews.com/pictures/radiation-sickness-8-terrifying-symptoms/

  Nausea and vomiting are typically the earliest symptoms of radiation sickness. The higher the dose of radiation, the sooner these symptoms appear – and the worse the prognosis. Someone who starts to vomit within one hour of exposure is likely to die. […] Radiation sickness can cause bleeding from the nose, mouth, gums, and rectum. It can cause people to bruise easily and to bleed internally as well – and even to vomit blood. […] Radiation sickness causes major irritation of the intestinal lining, resulting in severe and sometimes bloody diarrhea. […] Areas of skin exposed to radiation may turn blister and turn red – almost like a severe sunburn. In some cases open sores form. The skin may even slough off. […] Radiation damages hair follicles. As a result, people who get a big dose of radiation often lose their hair within two to three weeks. Sometimes the loss of hair is permanent.

• #1 Time Phases of Acute Radiation Syndrome (ARS) – Radiation Emergency Medical Management

  https://remm.hhs.gov/ars_timephases4.htm

  Recovery will require prolonged, aggressive supportive care. All victims who recover will require continued surveillance for late effects. Psychological support helpful […] Time to Death: Days to weeks depending on dose and clinical complications. Aggressive supportive care may extend survival and salvage selected patients.

• #1 Time Phases of Acute Radiation Syndrome (ARS) – Radiation Emergency Medical Management

  https://remm.hhs.gov/ars_timephases4.htm

  Acute Radiation Syndrome time phases resulting from 6-8 Gy radiation exposure […] Vomiting: Onset: Percent of victims who vomit at this dose: 100% […] Diarrhea: Heavy, Onset: 1-3 hours after exposure, Percent of victims with diarrhea at this dose: 10% at low end; at high end of dose range ~100% of victims affected […] Headache: Severe, Onset: 3-4 hours after exposure, Percent of victims with headache at this dose: 80% […] Body temperature: High fever, Percent of victims with fever at this dose: 100% […] Potential clinical effects: Anorexia, Fever, Malaise, weakness, Bleeding, infection, Epilation: hair is lost by day 11, Nausea, vomiting, Diarrhea: common by day 6-9; more severe with increased dose from exposure, Disorientation, Hypotension […] Lethality: Percent of victims who die at this dose: 50% beginning at 1-2 weeks

• #1 Radiation Sickness (Acute Radiation Syndrome)

  https://my.clevelandclinic.org/health/diseases/24328-radiation-sickness

  The prognosis (outlook) of radiation sickness depends on several factors, including: How much radiation your body absorbed. How much of your body was affected. If you were able to get immediate medical care. […] Radiation sickness is often fatal. The time to death decreases as the dose of radiation increases. […] With survivors, long-term complications may occur. Survivors have an increased likelihood of radiation-induced cancer, including leukemia and thyroid cancer.

• #1 Clinical manifestations, evaluation, and diagnosis of acute radiation exposure – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-evaluation-and-diagnosis-of-acute-radiation-exposure

  ARS subsyndromes — The four prominent subsyndromes of ARS, which may occur individually or in combination, are cutaneous, hematopoietic, gastrointestinal, and neurovascular. Although there are characteristic patterns of injury for each subsyndrome, the severity and time course may vary in a given individual based on the specific exposure. […] Cutaneous — Cutaneous manifestations of ARS vary with the nature of the exposure (ie, the types of ionizing particles and/or rays), dose, and interval since the exposure. Radiation effects of ionizing radiation on skin are dose-dependent: […] – ≥2 Gy — Early transient erythema […] – ≥3 Gy (300 rad) — Hair loss […] – ≥6 Gy — Erythema […] – >10 Gy — Dry desquamation […] – >15 Gy — Moist desquamation […] – >20 Gy — Necrosis […] The time between exposure and clinical manifestations varies inversely with the dose of radiation (ie, skin findings are seen sooner with a higher dose). Cutaneous effects usually begin with a prodrome of transient erythema within hours of exposure that may progress to intense burning or tingling, followed by a symptom-free interval of days to weeks. Secondary erythema usually develops in 5 to 21 days, but it may appear earlier with more significant exposure. For severe exposure, initial erythema may be followed by intense reddening, blistering, and ulceration that can proceed to necrosis of the exposed region. Very large skin doses may cause permanent hair loss, damage to sebaceous and sweat glands, atrophy, fibrosis, keloids, changes in skin pigmentation, and progressive fibrosis of the vasculature that may take months or years to fully evolve.

• #1 Radiation Exposure and Contamination – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/radiation-exposure-and-contamination/radiation-exposure-and-contamination

  The hematopoietic syndrome is the dominant manifestation after whole-body doses of approximately 1 to 6 Gy and consists of a generalized pancytopenia. A mild prodrome may begin after 1 to 6 hours, lasting 24 to 48 hours. […] Whole-body irradiation of up to ~1 Gy is unlikely to cause any symptoms. […] Cutaneous radiation injury is injury to the skin and underlying tissues due to acute radiation doses as low as 3 Gy. […] Radiation to almost any organ can have both acute and chronic adverse effects.

• #1 Clinical manifestations, evaluation, and diagnosis of acute radiation exposure – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-evaluation-and-diagnosis-of-acute-radiation-exposure

  Hematopoietic — Ionizing radiation has predictable dose- and time-dependent effects on hematopoiesis that are manifest as cytopenias (ie, neutropenia, lymphopenia, anemia, and thrombocytopenia) with resultant clinical consequences, including infections, weakness, and bleeding. The fall in lymphocyte count is related to the radiation dose absorbed, and sequential lymphocyte counts can be used to approximate the radiation dose and prognosis. Clinical manifestations of radiation-induced hematopoietic toxicity become apparent at doses >2 to 4 Gy (200 to 400 rad), but recovery may occur if bone marrow stem and progenitor cells are not completely eradicated. The earliest hematologic effect is a fall in the absolute lymphocyte count, which begins in the first hours after exposure and continues for several weeks before returning to baseline. Neutrophils, platelets, and red blood cells are affected subsequently: Neutropenia reaches a nadir at two to four weeks, when life-threatening infections can occur. Thrombocytopenia also occurs at this time and can persist for several months. Anemia develops from gastrointestinal blood loss, hemorrhage into organs and tissues, and bone marrow aplasia. Radiation can also have long-term consequences for immune function and is associated with the development of various myeloid malignancies.

• #1 Acute Radiation Syndrome : How Does Radiation Sickness Work? – CheckOrphan

  https://checkorphan.org/video/acute-radiation-syndrome-how-does-radiation-sickness-work/

  Acute Radiation Syndrome (ARS) (sometimes known as radiation toxicity or radiation sickness) is an acute illness caused by irradiation of the entire body (or most of the body) by a high dose of penetrating radiation in a very short period of time (usually a matter of minutes). […] The survival rate of patients with this syndrome decreases with increasing dose. The primary cause of death is the destruction of the bone marrow, resulting in infection and hemorrhage. […] Survival is extremely unlikely with this syndrome. Destructive and irreparable changes in the GI tract and bone marrow usually cause infection, dehydration, and electrolyte imbalance. Death usually occurs within 2 weeks. Damage to the gastrointestinal tract is one of the primary causes of morbidity and mortality following radiation exposure. […] Death occurs within 3 days. Death likely is due to collapse of the circulatory system as well as increased pressure in the confining cranial vault as the result of increased fluid content caused by edema, vasculitis, and meningitis.

• #1 Radiation Exposure and Contamination – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/radiation-exposure-and-contamination/radiation-exposure-and-contamination

  Clinical manifestations depend on whether radiation exposure involves the whole body (acute radiation syndrome) or is limited to a small portion of the body (focal radiation injury). […] After the whole body, or a large portion of the body, receives a high dose of penetrating radiation, several distinct syndromes may occur: Cerebrovascular syndrome, Gastrointestinal (GI) syndrome, Hematopoietic syndrome. […] These syndromes have 3 different phases: Prodromal phase (minutes to 2 days after exposure): Lethargy and GI symptoms (nausea, anorexia, vomiting, diarrhea) are possible. […] The GI syndrome is the dominant manifestation after whole-body doses of approximately 6 to 30 Gy. Prodromal symptoms, often marked, develop within about 1 hour and resolve within 2 days. During the latent period of 4 to 5 days, GI mucosal cells die. Cell death is followed by intractable nausea, vomiting, and diarrhea, which lead to severe dehydration and electrolyte imbalances, diminished plasma volume, and vascular collapse.

• #1 Clinical manifestations, evaluation, and diagnosis of acute radiation exposure – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-evaluation-and-diagnosis-of-acute-radiation-exposure

  Gastrointestinal — Gastrointestinal (GI) manifestations of ARS vary with the dose and time from exposure to radiation. The occurrence and timing of vomiting can be used with the absolute lymphocyte count to determine the dose of radiation exposure. The GI tract is vulnerable to radiation injury from damage to the mucosal barrier, loss of proliferative epithelial cells in the intestinal crypts, and effects on the vasculature. At doses as low as 1.5 Gy (150 rad), a prodromal syndrome of nausea, vomiting, and anorexia may be observed. Exposure to higher doses leads to more severe and/or persistent GI manifestations within five days of initial exposure. At doses >5 Gy, nausea, vomiting, and bloody diarrhea accompanied by malabsorption, massive fluid losses, hypovolemia, and cardiovascular collapse occur. The risk of death from sepsis is increased by disruption of the mucosal barrier coupled with the depleted immune system, and GI bleeding is exacerbated by thrombocytopenia.

• #1 Acute Radiation Exposure – Core EM

  https://coreem.net/core/acute-radiation-exposure/

  Mortality is caused by dehydration, electrolyte imbalances, bacterial translocation, bowel wall necrosis, and subsequent perforation. […] Occurs only with substantial irradiation and is universally fatal. […] Presentation includes the rapid onset of nausea and vomiting followed by confusion, imbalance, fever, hypotension, seizure, coma, and death. […] Early signs of cutaneous damage include erythema, inflammation, desquamation, pigmentation changes, and epilation. Late signs of damage may include blood vessel injury, chronic edema, pain, ulceration, and blue discoloration. Ultimately, reactions ranging from dermal thinning to recurrent ulcerations, tissue necrosis, and invasive fibrosis may occur.

• #1 Acute radiation syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Acute_radiation_syndrome

  Neurovascular syndrome typically occurs at absorbed doses greater than 30 grays (3,000 rad), though it may occur at doses as low as 10 grays (1,000 rad). It presents with neurological symptoms such as dizziness, headache, or decreased level of consciousness, occurring within minutes to a few hours, with an absence of vomiting, and is almost always fatal, even with aggressive intensive care. […] The prognosis for ARS is dependent on the exposure dose, with anything above 8 Gy being almost always lethal, even with medical care.

• #1 Clinical manifestations, evaluation, and diagnosis of acute radiation exposure – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-evaluation-and-diagnosis-of-acute-radiation-exposure

  Neurovascular syndrome — Manifestations of ionizing radiation on the central nervous system (CNS), called neurovascular syndrome, vary with the dose and time from exposure and range from nonspecific findings to severe cognitive and neurologic effects. CNS effects of radiation may begin as nausea, vomiting, and lethargy within minutes of exposure. With a lethal dose of radiation (ie, >10 Gy), a latent period lasting several hours is followed by severe incapacitation that progresses to coma and death within 24 to 48 hours. Disorientation, ataxia, prostration, seizures, fever, and hypotension occurring within 24 to 48 hours are also predictive of a lethal exposure. Autopsy reveals that these patients have focal hemorrhages with necrosis, white matter edema, demyelination, and significant microvascular damage.

• #1 Radiation Sickness – What You Need to Know

  https://www.drugs.com/cg/radiation-sickness.html

  Your skin will itch and become red and swollen within a few hours after exposure. The top layers of your skin will peel and the hair on your skin may fall out. Your skin will start to heal. Then your symptoms of itching, swelling, and redness will return. Complete healing may take up to a few years, depending on the dose of radiation.

• #1 Prodromal Phase of Acute Radiation Syndrome and Exposure Doses [MOE]

  https://www.env.go.jp/en/chemi/rhm/basic-info/1st/03-03-03.html

  From prodromal symptoms that appear within 48 hours after the exposure, exposure doses can roughly be estimated in the case of acute exposure. Exposure to radiation of 1 to 2 Gy may cause loss of appetite, nausea and vomiting. In addition, very mild headache appears. Exposure to radiation of 2 to 4 Gy may cause vomiting, mild headache or slight fever (1 to 3 hours, 10 to 80% incidence). Exposure of 4 to 6 Gy causes 100% incidence of vomiting within one hour after exposure and also causes moderate diarrhea and headache as well as 80 to 100% incidence of fever. Exposure of 6 to 8 Gy causes 100% incidence of vomiting within 30 minutes and also causes severe diarrhea/headache as well as 100% incidence of high fever. Furthermore, disturbance of consciousness may appear. Exposure to radiation exceeding 8 Gy causes 100% incidence of vomiting within 10 minutes and causes symptoms such as severe diarrhea/headache, high fever and loss of consciousness.

• #1 Radiation Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441931/

  The dose, symptom onset, and acute radiation syndrome subdivision are below. […] Supportive care saves lives when it comes to acute radiation syndrome. Fluid management and early treatment of any signs of infection will be fundamental to a better outcome. […] The following potassium iodide doses should be used daily while in the area of exposure: adult 130 mg, child 65 mg, and infants 1 month to child 3 years old 32 mg. […] Early use of antibiotics should be the rule. […] The use of bone marrow transplant has been used for large dose exposures but remains controversial. […] The differential diagnosis for radiation toxicity includes the following: Acute gastric dilation, Acetaminophen toxicity, Adrenal insufficiency, Appendicitis, Aspirin toxicity, Central nervous system tumor, Digoxin toxicity, Elevated intracranial pressure, Pancreatitis, Peritonitis.

• #1 Clinical manifestations, evaluation, and diagnosis of acute radiation exposure – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-evaluation-and-diagnosis-of-acute-radiation-exposure

  Clinical manifestations, evaluation, and diagnosis of acute radiation exposure […] Acute radiation syndrome (ARS) occurs hours, days, or weeks after whole-body exposure (or large partial-body exposure) to a sufficiently elevated dose of penetrating radiation during a short period of time, to cause clinically apparent injury. Initial clinical features are nonspecific and vary according to the degree and type of radiation exposure. Most commonly, ARS is manifest as cutaneous, gastrointestinal, hematologic, and/or neurologic findings. […] Magnitude of exposure — The signs and symptoms of ARS are related to the type of radiation and the absorbed dose of radiation. The threshold whole-body dose for ARS in adults is approximately 1 Gy (100 rad); lower doses are not expected to cause clinically apparent ARS. A whole-body dose of 4.5 Gy is lethal to 50 percent of exposed persons (LD50) and a dose of ≥10 Gy is typically associated with 100 percent mortality. All forms of ionizing radiation can cause internal tissue damage after ingestion, inhalation, and/or absorption through the skin or subcutaneous tissue. X-rays, gamma rays, and neutrons penetrate the skin and can cause deep tissue injury contamination. By contrast, external exposure to high-energy beta particles (without ingestion or inhalation) can cause skin damage but does not cause deep tissue injury, unless they are delivered at a high dose. Alpha particles are blocked by clothing and intact skin and are typically harmful only when the material that emits them are internalized via a wound, abrasion, ingestion after transfer from the hands to foodstuffs, or inhalation. Effects of radiation exposure also vary with the dose rate of radiation, shielding, and availability of medical care.

• #1 Commonalities Between COVID-19 and Radiation Injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7861125/

  As the multi-systemic components of COVID-19 emerge, parallel etiologies can be drawn between SARS-CoV-2 infection and radiation injuries. […] Interestingly, years of research in the field of radiation biology documents the complex multi-organ nature of another disease state that occurs after exposure to high doses of radiation: the acute radiation syndrome (ARS). Inflammation is a key common player in COVID-19 and ARS, and drives the multi-system damage that dramatically alters biological homeostasis. Both conditions initiate a cytokine storm, with similar pro-inflammatory molecules increased and other anti-inflammatory molecules decreased. […] In the case of COVID-19, the lung is the most prevalent initial target and, in some cases, the injury progresses from pneumonitis to acute respiratory distress syndrome (ARDS). This heightened chronic inflammatory response creates a pro-fibrotic environment that yields long-term fibrosis followed by organ dysfunction. Similarly, exposure to radiation can also result in lung fibrosis as well as injury to other organs.

• #1 Commonalities Between COVID-19 and Radiation Injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7861125/

  The cytokine storm is the nexus between SARS-CoV-2 infection and radiation exposure; both result in systemic inflammation that ravages the body. […] The presence of these proteins on a wide variety of cell types throughout the body such as airway epithelial cells, alveolar epithelial cells, lung macrophages and vascular endothelial cells explains the widespread damage caused by the infection. […] Despite the differences in the initial cause of injury, systemic inflammation and coagulopathy, including disseminated intravascular coagulation (DIC) are hallmarks of both COVID-19 and acute radiation injury, with pyroptosis and neutrophil extracellular traps found in both. […] These disease processes found in both COVID-19 and acute and delayed radiation syndromes may directly cause or further exacerbate injury and pathogenesis in multiple organ systems.

• #1 Radiation sickness: Sources, effects, and protection

  https://www.medicalnewstoday.com/articles/219615

  Radiation sickness describes damage to the body that occurs after a large dose of radiation. […] When radiation damages cells, it is irreversible. The more often a person is exposed, the greater their risk of health problems. […] Symptoms of severe radiation poisoning will normally go through four stages. […] The signs and symptoms of acute radiation poisoning are: vomiting, diarrhea, and nausea; loss of appetite; malaise, or feeling unwell; headache; rapid heartbeat. […] A dose of as low as 30 rads can lead to: loss of white blood cells; nausea and vomiting; headaches. […] A dose of 300 rads dose may result in: temporary hair loss; damage to nerve cells; damage to the cells that line the digestive tract. […] A person who is exposed to 3,000 rads will experience nausea and vomiting, and they may experience confusion and a loss of consciousness within a few hours. Tremors and convulsions will occur 5 to 6 hours after exposure. Within 3 days, there will be coma and death. […] People who experience repeated doses, or who appear to recover, may have long-term effects. […] The effects of radiation are cumulative. Damage to cells is irreversible.

• #1 Clinical manifestations, evaluation, and diagnosis of acute radiation exposure – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-evaluation-and-diagnosis-of-acute-radiation-exposure

  – Manifest ARS (21 to 60 days after exposure) — Manifest ARS follows a predictable pattern that generally begins with infection, anemia, and bleeding; followed by uncontrollable diarrhea, hypovolemia, and electrolyte disturbances; and finally, deteriorating mental status, cerebral edema, and overwhelming cardiovascular collapse. […] – Recovery phase — The recovery phase refers to the period after manifest ARS where the patient recovers from the acute exposure. The timing for recovery will depend on the severity of injury and affected organ system(s). […] Even after recovery from acute radiation injury, the patient remains at risk for chronic injury and long-term complications, such as the Delayed Effects of Acute Radiation Exposure (DEARE) that include pulmonary fibrosis and cataracts. Patients may also be at increased risk of developing myelodysplastic syndrome, various leukemias, solid tumors (eg, cancer of the thyroid, breast, and brain), and thyroid disease. Long-term effects are similar to those after therapeutic radiation.

• #1 Radiation sickness – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/radiation-sickness/diagnosis-treatment/drc-20377061

  When a person has experienced known or probable exposure to a high dose of radiation from an accident or attack, medical personnel take a number of steps to determine the absorbed radiation dose. This information is essential for determining how serious the illness is likely to be, which treatments to use and whether a person is likely to survive. […] The time between radiation exposure and when vomiting starts is a fairly accurate screening tool to estimate absorbed radiation dose. The shorter the time before vomiting starts, the higher the dose. The severity and timing of other symptoms also may help medical personnel determine the absorbed dose. […] The treatment goals for radiation sickness are to prevent further radioactive contamination; treat life-threatening injuries, such as from burns and trauma; reduce symptoms; and manage pain.

• #2 Radiation Sickness (Acute Radiation Syndrome)

  https://my.clevelandclinic.org/health/diseases/24328-radiation-sickness

  The prognosis (outlook) of radiation sickness depends on several factors, including: How much radiation your body absorbed. How much of your body was affected. If you were able to get immediate medical care. […] Radiation sickness is often fatal. The time to death decreases as the dose of radiation increases. […] With survivors, long-term complications may occur. Survivors have an increased likelihood of radiation-induced cancer, including leukemia and thyroid cancer.

• #2 Radiation Sickness | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688608/all/Radiation_Sickness?q=Vomiting

  Radiation sickness, or acute radiation syndrome (ARS), is defined as an acute illness caused by radiation of most or all of the body with a relatively high dose of radiation over a short period of time. […] Four major stages in ARS: prodrome, latent phase, illness, and either recovery or death. The higher the radiation doses, the shorter and more severe each stage: […] The prodrome appears within minutes to 4 days of postexposure, lasts between a few hours and a few days, and can include nausea and vomiting. […] Latent phase lasts from hours to several weeks when an individual feels quite well. […] Illness phase usually starts from 1st day to the 2nd week with an abrupt onset. […] Recovery phase may take weeks to more than a month. […] Time within and progression through these stages is dependent in part on access to, and availability of, treatment and, in part, on total dose received.

• #2 Radiation Sickness (Acute Radiation Syndrome)

  https://my.clevelandclinic.org/health/diseases/24328-radiation-sickness

  Radiation sickness can cause a range of symptoms at first, which include feeling weak, confused, feverish and sick to your stomach. […] Symptoms may begin right after exposure or over the next few days, weeks or months. While symptoms vary based on the syndrome type, the first signs and symptoms of radiation sickness include: Weakness or fatigue. Nausea and vomiting. Vomiting blood. Rectal bleeding (bloody stools). Diarrhea. Fever. Confusion. Hair loss. Tenderness, discoloration, swelling or a burning sensation in your skin. […] Later, symptoms and complications unfold in stages related to the three ARS syndromes. […] Each acute radiation syndrome (ARS) has distinct stages. They are the: Prodromal stage: Initial symptoms start minutes to two days after exposure. Latent asymptomatic stage: A period with no symptoms begins hours to 21 days after exposure. Systemic illness stage: More severe symptoms and changes in your body start hours to fewer than 60 days after exposure. Symptoms vary based on the type of syndrome.

• #2 Radiation sickness | Altru Health System

  https://www.altru.org/health-library/conditions/radiation-sickness

  Radiation sickness is damage to your body caused by a large dose of radiation often received over a short period of time (acute). The amount of radiation absorbed by the body the absorbed dose determines how sick you’ll be. […] The severity of signs and symptoms of radiation sickness depends on how much radiation you’ve absorbed. How much you absorb depends on the strength of the radiated energy, the time of your exposures, and the distance between you and the source of radiation. […] The initial signs and symptoms of treatable radiation sickness are usually nausea and vomiting. The amount of time between exposure and when these symptoms develop is a clue to how much radiation a person has absorbed. […] After the first round of signs and symptoms, a person with radiation sickness may have a brief period with no apparent illness, followed by the onset of new, more-serious symptoms.

• #2 Acute radiation syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Acute_radiation_syndrome

  Neurovascular syndrome typically occurs at absorbed doses greater than 30 grays (3,000 rad), though it may occur at doses as low as 10 grays (1,000 rad). It presents with neurological symptoms such as dizziness, headache, or decreased level of consciousness, occurring within minutes to a few hours, with an absence of vomiting, and is almost always fatal, even with aggressive intensive care. […] The prognosis for ARS is dependent on the exposure dose, with anything above 8 Gy being almost always lethal, even with medical care.

• #2 Clinical manifestations, evaluation, and diagnosis of acute radiation exposure – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-evaluation-and-diagnosis-of-acute-radiation-exposure

  Time course of ARS — ARS progresses through four phases, and the onset, duration of the phases, and dominant manifestations of the syndrome depend on the dose of radiation: […] – Prodromal phase (0 to 2 days after exposure) — The prodromal phase refers to early symptoms or signs, which are generally nonspecific. At doses between 1 and 2 Gy, a prodrome that may include anorexia, nausea, vomiting, fatigue, tachycardia, fever, and/or headache becomes evident. Early onset (eg, <2 hours after exposure) and persistence of nausea, vomiting, and/or diarrhea indicates a severe radiation exposure. [...] - Latent phase (2 to 20 days after exposure) — The latent phase is a period of improvement in prodromal symptoms. The duration of the latent phase is inversely related to the dose of radiation received, and patients with severe, lethal exposure may progress directly from prodromal phase to manifest illness.

• #2 Clinical manifestations, evaluation, and diagnosis of acute radiation exposure – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-evaluation-and-diagnosis-of-acute-radiation-exposure

  – Manifest ARS (21 to 60 days after exposure) — Manifest ARS follows a predictable pattern that generally begins with infection, anemia, and bleeding; followed by uncontrollable diarrhea, hypovolemia, and electrolyte disturbances; and finally, deteriorating mental status, cerebral edema, and overwhelming cardiovascular collapse. […] – Recovery phase — The recovery phase refers to the period after manifest ARS where the patient recovers from the acute exposure. The timing for recovery will depend on the severity of injury and affected organ system(s). […] Even after recovery from acute radiation injury, the patient remains at risk for chronic injury and long-term complications, such as the Delayed Effects of Acute Radiation Exposure (DEARE) that include pulmonary fibrosis and cataracts. Patients may also be at increased risk of developing myelodysplastic syndrome, various leukemias, solid tumors (eg, cancer of the thyroid, breast, and brain), and thyroid disease. Long-term effects are similar to those after therapeutic radiation.

• #2 Mayo Clinic Health Library – Radiation sickness | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20377044

  If you’ve had a mild exposure, it may take hours to weeks before symptoms begin. But with high exposure, symptoms can begin minutes to days after exposure. […] Possible symptoms include: Nausea and vomiting. Diarrhea. Headache. Fever. Dizziness and disorientation. Weakness and fatigue. Hair loss. Bloody vomit and stools from internal bleeding. Infections. Low blood pressure.

• #2 Radiation sickness: 8 terrifying symptoms

  https://www.cbsnews.com/pictures/radiation-sickness-8-terrifying-symptoms/

  Radiation sickness can cause people to feel weak and out of sorts – almost like having a bad version of the flu. It can dramatically reduce the number of red blood cells, causing anemia and and increased risk of fainting. […] Radiation sickness can cause visible ulcers in or on the mouth. In addition, ulcers often form in the esophagus, stomach, and intestines. […] Along with red cells, radiation sickness can reduce the risk of infection-fighting white cells in the body. As a result, the risk of bacterial, viral, and fungal infections is heightened.

• #2 Time Phases of Acute Radiation Syndrome (ARS) – Radiation Emergency Medical Management

  https://remm.hhs.gov/ars_timephases4.htm

  Recovery will require prolonged, aggressive supportive care. All victims who recover will require continued surveillance for late effects. Psychological support helpful […] Time to Death: Days to weeks depending on dose and clinical complications. Aggressive supportive care may extend survival and salvage selected patients.

• #2 Radiation damage Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/condition/radiation-damage

  Radiation sickness or radiation emergency happens after exposure to a large amount of radiation. Acute radiation sickness occurs within 24 hours of exposure. Chronic radiation syndrome is a range of symptoms occurring over a period of time. These symptoms can happen immediately or months or years after exposure to radiation: […] Radiation syndrome includes fatigue, weight loss, nausea, vomiting, diarrhea, sweating, fever, headache with bleeding and complications affecting the digestive system, nervous system, heart, and lungs. […] The prognosis depends on the level of radiation exposure, how quickly the person can be treated, and how detailed the follow up is. Long-term complications may include cancer, liver failure, infertility, and thickening and scarring of lung, liver, and kidney tissue.

• #2 Clinical manifestations, evaluation, and diagnosis of acute radiation exposure – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-evaluation-and-diagnosis-of-acute-radiation-exposure

  Hematopoietic — Ionizing radiation has predictable dose- and time-dependent effects on hematopoiesis that are manifest as cytopenias (ie, neutropenia, lymphopenia, anemia, and thrombocytopenia) with resultant clinical consequences, including infections, weakness, and bleeding. The fall in lymphocyte count is related to the radiation dose absorbed, and sequential lymphocyte counts can be used to approximate the radiation dose and prognosis. Clinical manifestations of radiation-induced hematopoietic toxicity become apparent at doses >2 to 4 Gy (200 to 400 rad), but recovery may occur if bone marrow stem and progenitor cells are not completely eradicated. The earliest hematologic effect is a fall in the absolute lymphocyte count, which begins in the first hours after exposure and continues for several weeks before returning to baseline. Neutrophils, platelets, and red blood cells are affected subsequently: Neutropenia reaches a nadir at two to four weeks, when life-threatening infections can occur. Thrombocytopenia also occurs at this time and can persist for several months. Anemia develops from gastrointestinal blood loss, hemorrhage into organs and tissues, and bone marrow aplasia. Radiation can also have long-term consequences for immune function and is associated with the development of various myeloid malignancies.

• #2 Radiation Injury – Injuries and Poisoning – MSD Manual Consumer Version

  https://www.msdmanuals.com/home/injuries-and-poisoning/radiation-injury/radiation-injury

  The severity and time course of the early symptoms are fairly consistent from person to person for a given amount of radiation exposure. Thus, doctors can often estimate a person’s radiation exposure based on the timing, nature, and severity of the early symptoms. […] The hematopoietic syndrome is caused by the effects of radiation on the bone marrow, spleen, and lymph nodes—the primary sites of blood cell production (hematopoiesis). Loss of appetite (anorexia), lethargy, nausea, and vomiting may begin 1 to 6 hours after exposure to 1 to 6 Gy of radiation. […] The gastrointestinal syndrome is due to the effects of radiation on the cells lining the digestive tract. Severe nausea, vomiting, and diarrhea may begin in less than 1 hour after exposure to 6 Gy or more of radiation. […] The cerebrovascular syndrome occurs when the total dose of radiation exceeds 30 Gy. People rapidly develop confusion, nausea, vomiting, bloody diarrhea, tremors, and shock.

• #2 Clinical manifestations, evaluation, and diagnosis of acute radiation exposure – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-evaluation-and-diagnosis-of-acute-radiation-exposure

  Gastrointestinal — Gastrointestinal (GI) manifestations of ARS vary with the dose and time from exposure to radiation. The occurrence and timing of vomiting can be used with the absolute lymphocyte count to determine the dose of radiation exposure. The GI tract is vulnerable to radiation injury from damage to the mucosal barrier, loss of proliferative epithelial cells in the intestinal crypts, and effects on the vasculature. At doses as low as 1.5 Gy (150 rad), a prodromal syndrome of nausea, vomiting, and anorexia may be observed. Exposure to higher doses leads to more severe and/or persistent GI manifestations within five days of initial exposure. At doses >5 Gy, nausea, vomiting, and bloody diarrhea accompanied by malabsorption, massive fluid losses, hypovolemia, and cardiovascular collapse occur. The risk of death from sepsis is increased by disruption of the mucosal barrier coupled with the depleted immune system, and GI bleeding is exacerbated by thrombocytopenia.

• #2 Radiation Exposure and Contamination – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/radiation-exposure-and-contamination/radiation-exposure-and-contamination

  Clinical manifestations depend on whether radiation exposure involves the whole body (acute radiation syndrome) or is limited to a small portion of the body (focal radiation injury). […] After the whole body, or a large portion of the body, receives a high dose of penetrating radiation, several distinct syndromes may occur: Cerebrovascular syndrome, Gastrointestinal (GI) syndrome, Hematopoietic syndrome. […] These syndromes have 3 different phases: Prodromal phase (minutes to 2 days after exposure): Lethargy and GI symptoms (nausea, anorexia, vomiting, diarrhea) are possible. […] The GI syndrome is the dominant manifestation after whole-body doses of approximately 6 to 30 Gy. Prodromal symptoms, often marked, develop within about 1 hour and resolve within 2 days. During the latent period of 4 to 5 days, GI mucosal cells die. Cell death is followed by intractable nausea, vomiting, and diarrhea, which lead to severe dehydration and electrolyte imbalances, diminished plasma volume, and vascular collapse.

• #2 Clinical manifestations, evaluation, and diagnosis of acute radiation exposure – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-evaluation-and-diagnosis-of-acute-radiation-exposure

  Neurovascular syndrome — Manifestations of ionizing radiation on the central nervous system (CNS), called neurovascular syndrome, vary with the dose and time from exposure and range from nonspecific findings to severe cognitive and neurologic effects. CNS effects of radiation may begin as nausea, vomiting, and lethargy within minutes of exposure. With a lethal dose of radiation (ie, >10 Gy), a latent period lasting several hours is followed by severe incapacitation that progresses to coma and death within 24 to 48 hours. Disorientation, ataxia, prostration, seizures, fever, and hypotension occurring within 24 to 48 hours are also predictive of a lethal exposure. Autopsy reveals that these patients have focal hemorrhages with necrosis, white matter edema, demyelination, and significant microvascular damage.

• #2 Acute Radiation Syndrome: Symptoms, Treatment, and Recovery

  https://www.healthline.com/health/acute-radiation-syndrome

  This subtype of ARS can cause: severe nausea, vomiting, diarrhea, confusion, nervousness, loss of consciousness, convulsions, coma. […] For instance, cardiovascular/central nervous system ARS is always fatal, but many people with bone marrow ARS make a complete recovery. […] The symptoms and their severity depend on the amount of exposure. In the most severe cases, ARS is fatal, but if you have exposure to smaller amounts of radiation, you can make a full recovery.

• #2 Health Impacts of Radiation Exposure | Union of Concerned Scientists

  https://www.ucsusa.org/resources/health-impacts-radiation-exposure

  Radiation is associated with a wide range of adverse health outcomes, including acute radiation sickness, burns, cancer, cardiovascular disease, or even death. […] Acute radiation syndrome (ARS) can also occur after a high-dose, sudden exposure, when the radiation can penetrate to internal organs and all or most of the body is exposed. This is also commonly referred to as radiation sickness. Symptoms include nausea, vomiting, headache, and diarrhea within hours after exposure, and may cause death in the following days or weeks. The dose range for radiation sickness is 70 rads or 0.7 Gy, and mild symptoms may be observed at doses as low as 0.3 Gy or 30 rads. There are known acute effects to the brain, thyroid, blood, heart, gastrointestinal tract, reproductive system, and even hair at doses of 200 rem and higher. […] Acute exposure to radiation (as in direct contact with radioactive material or being near a nuclear detonation) can result in cutaneous radiation injury (CRI), a skin burn that can occur at radiation doses as low as 2 grays (Gy) or 200 rads2, increasing in severity as the dose increases.

• #2 Clinical manifestations, evaluation, and diagnosis of acute radiation exposure – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-evaluation-and-diagnosis-of-acute-radiation-exposure

  ARS subsyndromes — The four prominent subsyndromes of ARS, which may occur individually or in combination, are cutaneous, hematopoietic, gastrointestinal, and neurovascular. Although there are characteristic patterns of injury for each subsyndrome, the severity and time course may vary in a given individual based on the specific exposure. […] Cutaneous — Cutaneous manifestations of ARS vary with the nature of the exposure (ie, the types of ionizing particles and/or rays), dose, and interval since the exposure. Radiation effects of ionizing radiation on skin are dose-dependent: […] – ≥2 Gy — Early transient erythema […] – ≥3 Gy (300 rad) — Hair loss […] – ≥6 Gy — Erythema […] – >10 Gy — Dry desquamation […] – >15 Gy — Moist desquamation […] – >20 Gy — Necrosis […] The time between exposure and clinical manifestations varies inversely with the dose of radiation (ie, skin findings are seen sooner with a higher dose). Cutaneous effects usually begin with a prodrome of transient erythema within hours of exposure that may progress to intense burning or tingling, followed by a symptom-free interval of days to weeks. Secondary erythema usually develops in 5 to 21 days, but it may appear earlier with more significant exposure. For severe exposure, initial erythema may be followed by intense reddening, blistering, and ulceration that can proceed to necrosis of the exposed region. Very large skin doses may cause permanent hair loss, damage to sebaceous and sweat glands, atrophy, fibrosis, keloids, changes in skin pigmentation, and progressive fibrosis of the vasculature that may take months or years to fully evolve.

• #2 Radiation sickness: 8 terrifying symptoms

  https://www.cbsnews.com/pictures/radiation-sickness-8-terrifying-symptoms/

  Nausea and vomiting are typically the earliest symptoms of radiation sickness. The higher the dose of radiation, the sooner these symptoms appear – and the worse the prognosis. Someone who starts to vomit within one hour of exposure is likely to die. […] Radiation sickness can cause bleeding from the nose, mouth, gums, and rectum. It can cause people to bruise easily and to bleed internally as well – and even to vomit blood. […] Radiation sickness causes major irritation of the intestinal lining, resulting in severe and sometimes bloody diarrhea. […] Areas of skin exposed to radiation may turn blister and turn red – almost like a severe sunburn. In some cases open sores form. The skin may even slough off. […] Radiation damages hair follicles. As a result, people who get a big dose of radiation often lose their hair within two to three weeks. Sometimes the loss of hair is permanent.

• #2

  https://flutrackers.com/forum/forum/health-humanitarian-issues/105241-recognizing-and-treating-radiation-sickness

  There is no cure for radiation sickness, which is caused by body tissue exposed to radioactive substances. The symptoms are treated on a case by case basis since the degree of sickness and the symptoms vary from person to person. The effects cannot be reversed, but if they’re treated in a timely manner the damage may be contained. […] The severity of signs and symptoms of radiation sickness depends on how much radiation you’ve absorbed. How much you absorb depends on the strength of the radiated energy and the distance between you and the source of radiation. […] Signs and symptoms of radiation sickness usually appear when the entire body receives an absorbed dose of at least 1 Gy. Doses greater than 6 Gy to the whole body are generally not treatable and usually lead to death within two days to two weeks, depending on the dose and duration of the exposure.

• #2 Clinical manifestations, evaluation, and diagnosis of acute radiation exposure – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-evaluation-and-diagnosis-of-acute-radiation-exposure

  Clinical manifestations, evaluation, and diagnosis of acute radiation exposure […] Acute radiation syndrome (ARS) occurs hours, days, or weeks after whole-body exposure (or large partial-body exposure) to a sufficiently elevated dose of penetrating radiation during a short period of time, to cause clinically apparent injury. Initial clinical features are nonspecific and vary according to the degree and type of radiation exposure. Most commonly, ARS is manifest as cutaneous, gastrointestinal, hematologic, and/or neurologic findings. […] Magnitude of exposure — The signs and symptoms of ARS are related to the type of radiation and the absorbed dose of radiation. The threshold whole-body dose for ARS in adults is approximately 1 Gy (100 rad); lower doses are not expected to cause clinically apparent ARS. A whole-body dose of 4.5 Gy is lethal to 50 percent of exposed persons (LD50) and a dose of ≥10 Gy is typically associated with 100 percent mortality. All forms of ionizing radiation can cause internal tissue damage after ingestion, inhalation, and/or absorption through the skin or subcutaneous tissue. X-rays, gamma rays, and neutrons penetrate the skin and can cause deep tissue injury contamination. By contrast, external exposure to high-energy beta particles (without ingestion or inhalation) can cause skin damage but does not cause deep tissue injury, unless they are delivered at a high dose. Alpha particles are blocked by clothing and intact skin and are typically harmful only when the material that emits them are internalized via a wound, abrasion, ingestion after transfer from the hands to foodstuffs, or inhalation. Effects of radiation exposure also vary with the dose rate of radiation, shielding, and availability of medical care.

• #2 Acute Radiation Syndrome: Information for Clinicians | Radiation Emergencies | CDC

  https://www.cdc.gov/radiation-emergencies/hcp/clinical-guidance/ars.html

  Symptoms are extreme nervousness and confusion; severe nausea, vomiting, and watery diarrhea; loss of consciousness; and burning sensations of the skin. Onset occurs within minutes of exposure. Stage lasts for minutes to hours. […] If a patient received more than 0.05 Gy (5 rads) and three or four CBCs are taken within 8 to 12 hours of the exposure, a quick estimate of the dose can be made. […] Treat vomiting, and repeat CBC analysis, with special attention to the lymphocyte count, every 2 to 3 hours for the first 8 to 12 hours following exposure (and every 4 to 6 hours for the following 2 or 3 days). Sequential changes in absolute lymphocyte counts over time are demonstrated below in the Andrews Lymphocyte Nomogram. […] If no radiation exposure is initially suspected, you may consider ARS in the differential diagnosis if a history exists of nausea and vomiting that is unexplained by other causes.

• #2 Health Library

  https://www.limamemorial.org/m/health-library/HIE%20Multimedia-TextOnly/1/000026

  Radiation sickness is illness and symptoms resulting from excessive exposure to ionizing radiation. […] Radiation sickness results when humans (or other animals) are exposed to very large doses of ionizing radiation. […] Radiation sickness is generally associated with acute exposure and has a characteristic set of symptoms that appear in an orderly fashion. […] The severity of symptoms and illness (acute radiation sickness) depends on the type and amount of radiation, how long you were exposed, and which part of the body was exposed. Symptoms of radiation sickness may occur right after exposure, or over the next few days, weeks, or months. […] Symptoms of radiation sickness may include: Weakness, fatigue, fainting, confusion; Bleeding from the nose, mouth, gums, and rectum; Bruising, skin burns, open sores on the skin, sloughing of skin; Dehydration; Diarrhea, bloody stool; Fever; Hair loss; Inflammation of exposed areas (redness, tenderness, swelling, bleeding); Nausea and vomiting, including vomiting of blood; Ulcers (sores) in the mouth, esophagus (food pipe), stomach or intestines.

• #2 Acute radiation syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Acute_radiation_syndrome

  Symptoms can start within an hour of exposure, and can last for several months. Early symptoms are usually nausea, vomiting and loss of appetite. In the following hours or weeks, initial symptoms may appear to improve, before the development of additional symptoms, after which either recovery or death follows. […] Early symptoms of ARS typically include nausea, vomiting, headaches, fatigue, fever, and a short period of skin reddening. These symptoms may occur at radiation doses as low as 0.35 grays (35 rad). These symptoms are common to many illnesses, and may not, by themselves, indicate acute radiation sickness. […] The speed of symptom onset is related to radiation exposure, with greater doses resulting in a shorter delay in symptom onset. […] The signs and symptoms of this form of radiation injury include nausea, vomiting, loss of appetite, and abdominal pain. Vomiting in this time-frame is a marker for whole body exposures that are in the fatal range above 4 grays (400 rad). Without exotic treatment such as bone marrow transplant, death with this dose is common, due generally more to infection than gastrointestinal dysfunction.

• #2

  https://flutrackers.com/forum/forum/health-humanitarian-issues/105241-recognizing-and-treating-radiation-sickness

  The initial signs and symptoms of treatable radiation sickness are usually nausea and vomiting. The amount of time between exposure and when these symptoms develop is an indicator of how much radiation a person has absorbed. After the first round of signs and symptoms, a person with radiation sickness may have a brief period with no apparent illness, followed by the onset of new, more serious symptoms. In general, the greater your radiation exposure, the more rapid and more severe your symptoms will be. […] If you have radiation sickness, you may receive additional medications or interventions to treat bacterial infections, headache, fever, diarrhea, nausea and vomiting, and dehydration. […] A person who has absorbed large doses of radiation (6 Gy or greater) has little chance of recovery. Depending on the severity of illness, death can occur within two days or two weeks.

• #2 Radiation Sickness: Facts, Symptoms, Treatment

  https://www.webmd.com/cancer/radiation-sickness-facts

  Radiation sickness happens when a large dose of high-energy radiation goes through your body and reaches your internal organs. […] The most common early symptoms of radiation sickness are the same as for many other illnesses — nausea, vomiting, and diarrhea. They can start within minutes of exposure, but they may come and go for several days. […] You might also have skin damage, like a bad sunburn, or get blisters or sores. Radiation may also damage the cells that make hair, causing your hair to fall out. In some cases, hair loss might be permanent. […] The symptoms can go away entirely for anywhere from a few hours to weeks. But if they come back, they’re often worse.

• #2 Commonalities Between COVID-19 and Radiation Injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7861125/

  The cytokine storm is the nexus between SARS-CoV-2 infection and radiation exposure; both result in systemic inflammation that ravages the body. […] The presence of these proteins on a wide variety of cell types throughout the body such as airway epithelial cells, alveolar epithelial cells, lung macrophages and vascular endothelial cells explains the widespread damage caused by the infection. […] Despite the differences in the initial cause of injury, systemic inflammation and coagulopathy, including disseminated intravascular coagulation (DIC) are hallmarks of both COVID-19 and acute radiation injury, with pyroptosis and neutrophil extracellular traps found in both. […] These disease processes found in both COVID-19 and acute and delayed radiation syndromes may directly cause or further exacerbate injury and pathogenesis in multiple organ systems.

• #2 Symptoms of Delayed Radiation Injury

  https://www.hyperbaricmedicalsolutions.com/blog/symptoms-of-delayed-radiation-injury

  Radiation therapy is commonly used to treat cancer by targeting malignant tumors in the body such as the prostate, the head and neck, the throat, and the breast and destroying cancer cells to prevent them from spreading. […] Those who have gone through a normal course of radiation therapy may be at risk of suffering from delayed radiation injuries that can significantly impact their health. […] A delayed radiation injury can occur anywhere from six months to more than 30 years after the initial treatment. These side effects can vary, depending upon the area of the body that was radiated. […] The type of cancer treated typically affects the area where symptoms of delayed radiation injury appear; however, these are not limited to the original treatment location. […] Those treated for prostate cancer, which involves targeting the pelvis with radiation, may notice certain symptoms elsewhere, including: Rectal pain, Abdominal pain, Hematuria (blood in your urine), Rectal bleeding, Proctitis, Bloating, Urinary incontinence, Severe dysuria, Erectile dysfunction.

• #3 Health Library

  https://www.limamemorial.org/m/health-library/HIE%20Multimedia-TextOnly/1/000026

  Radiation sickness is illness and symptoms resulting from excessive exposure to ionizing radiation. […] Radiation sickness results when humans (or other animals) are exposed to very large doses of ionizing radiation. […] Radiation sickness is generally associated with acute exposure and has a characteristic set of symptoms that appear in an orderly fashion. […] The severity of symptoms and illness (acute radiation sickness) depends on the type and amount of radiation, how long you were exposed, and which part of the body was exposed. Symptoms of radiation sickness may occur right after exposure, or over the next few days, weeks, or months. […] Symptoms of radiation sickness may include: Weakness, fatigue, fainting, confusion; Bleeding from the nose, mouth, gums, and rectum; Bruising, skin burns, open sores on the skin, sloughing of skin; Dehydration; Diarrhea, bloody stool; Fever; Hair loss; Inflammation of exposed areas (redness, tenderness, swelling, bleeding); Nausea and vomiting, including vomiting of blood; Ulcers (sores) in the mouth, esophagus (food pipe), stomach or intestines.

• #3 Radiation sickness – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/radiation-sickness/diagnosis-treatment/drc-20377061

  When a person has experienced known or probable exposure to a high dose of radiation from an accident or attack, medical personnel take a number of steps to determine the absorbed radiation dose. This information is essential for determining how serious the illness is likely to be, which treatments to use and whether a person is likely to survive. […] The time between radiation exposure and when vomiting starts is a fairly accurate screening tool to estimate absorbed radiation dose. The shorter the time before vomiting starts, the higher the dose. The severity and timing of other symptoms also may help medical personnel determine the absorbed dose. […] The treatment goals for radiation sickness are to prevent further radioactive contamination; treat life-threatening injuries, such as from burns and trauma; reduce symptoms; and manage pain.

• #3 Prodromal Phase of Acute Radiation Syndrome and Exposure Doses [MOE]

  https://www.env.go.jp/en/chemi/rhm/basic-info/1st/03-03-03.html

  From prodromal symptoms that appear within 48 hours after the exposure, exposure doses can roughly be estimated in the case of acute exposure. Exposure to radiation of 1 to 2 Gy may cause loss of appetite, nausea and vomiting. In addition, very mild headache appears. Exposure to radiation of 2 to 4 Gy may cause vomiting, mild headache or slight fever (1 to 3 hours, 10 to 80% incidence). Exposure of 4 to 6 Gy causes 100% incidence of vomiting within one hour after exposure and also causes moderate diarrhea and headache as well as 80 to 100% incidence of fever. Exposure of 6 to 8 Gy causes 100% incidence of vomiting within 30 minutes and also causes severe diarrhea/headache as well as 100% incidence of high fever. Furthermore, disturbance of consciousness may appear. Exposure to radiation exceeding 8 Gy causes 100% incidence of vomiting within 10 minutes and causes symptoms such as severe diarrhea/headache, high fever and loss of consciousness.

• #3 Radiation Sickness | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688608/all/Radiation_Sickness?q=Vomiting

  Radiation sickness, or acute radiation syndrome (ARS), is defined as an acute illness caused by radiation of most or all of the body with a relatively high dose of radiation over a short period of time. […] Four major stages in ARS: prodrome, latent phase, illness, and either recovery or death. The higher the radiation doses, the shorter and more severe each stage: […] The prodrome appears within minutes to 4 days of postexposure, lasts between a few hours and a few days, and can include nausea and vomiting. […] Latent phase lasts from hours to several weeks when an individual feels quite well. […] Illness phase usually starts from 1st day to the 2nd week with an abrupt onset. […] Recovery phase may take weeks to more than a month. […] Time within and progression through these stages is dependent in part on access to, and availability of, treatment and, in part, on total dose received.

• #3 Time Phases of Acute Radiation Syndrome (ARS) – Radiation Emergency Medical Management

  https://remm.hhs.gov/ars_timephases1.htm

  Acute Radiation Syndrome time phases resulting from 1-2 Gy radiation exposure […] Vomiting: Onset: 2 hours after exposure or later. Percent of victims who vomit at this dose: ~10-50%. […] Duration: From end of prodrome through day 21-35. […] Onset: 30 days after prodrome. […] Possible clinical effects: Fatigue, Weakness. […] Lethality: None likely from radiation alone. […] Recovery: Expected unless complicated by trauma or chronic illness. Counseling and long-term effects monitoring may be helpful and is critical for pregnant victims. Psychological support helpful.

• #3 Radiation sickness: 8 terrifying symptoms

  https://www.cbsnews.com/pictures/radiation-sickness-8-terrifying-symptoms/

  Nausea and vomiting are typically the earliest symptoms of radiation sickness. The higher the dose of radiation, the sooner these symptoms appear – and the worse the prognosis. Someone who starts to vomit within one hour of exposure is likely to die. […] Radiation sickness can cause bleeding from the nose, mouth, gums, and rectum. It can cause people to bruise easily and to bleed internally as well – and even to vomit blood. […] Radiation sickness causes major irritation of the intestinal lining, resulting in severe and sometimes bloody diarrhea. […] Areas of skin exposed to radiation may turn blister and turn red – almost like a severe sunburn. In some cases open sores form. The skin may even slough off. […] Radiation damages hair follicles. As a result, people who get a big dose of radiation often lose their hair within two to three weeks. Sometimes the loss of hair is permanent.

• #3 Radiation Sickness – Symptoms, Causes And Treatment

  https://www.apollohospitals.com/corporate/health-library/radiation-sickness/

  Other symptoms will follow and these include: Severe headache, Fever, Infections, Nausea and vomiting, Low blood pressure, Weakness and exhaustion, Hair loss, Diarrhea, Vomit with blood, Blood in stools. […] A person who has absorbed huge amounts of radiation will have this illness. This can even lead to death. An individual with a lethal radiation exposure will need immediate treatments. […] About 5 or 6 hours after the initial radiation exposure, symptoms will start, and ultimately, can even be fatal.

• #3 Understanding Radiation Sickness: Symptoms, Causes, and Treatment of Acute Radiation Syndrome – Raybloc X-ray Protection

  https://raybloc.com/radiation-sickness/

  Radiation sickness, also known as acute radiation syndrome (ARS), is a serious condition resulting from a high dose of ionising radiation in a short period of time. […] Understanding the stages is crucial for timely diagnosis and effective treatment. The illness unfolds in distinct phases, each characterised by a specific set of symptoms and medical implications: […] Symptoms include nausea, vomiting, and diarrhoea (N-V-D), starting within minutes to days after exposure and lasting up to several days. […] This stage may last from a few hours to a few weeks, during which symptoms may temporarily disappear. […] Symptoms depend on the amount of radiation exposure but typically include skin burns and radiation injuries. […] Recovery may take from several weeks to two years, depending on the radiation dose. In severe cases, death may occur.

• #3 Acute radiation syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Acute_radiation_syndrome

  Neurovascular syndrome typically occurs at absorbed doses greater than 30 grays (3,000 rad), though it may occur at doses as low as 10 grays (1,000 rad). It presents with neurological symptoms such as dizziness, headache, or decreased level of consciousness, occurring within minutes to a few hours, with an absence of vomiting, and is almost always fatal, even with aggressive intensive care. […] The prognosis for ARS is dependent on the exposure dose, with anything above 8 Gy being almost always lethal, even with medical care.

• #3 Acute Radiation Exposure – Core EM

  https://coreem.net/core/acute-radiation-exposure/

  Mortality is caused by dehydration, electrolyte imbalances, bacterial translocation, bowel wall necrosis, and subsequent perforation. […] Occurs only with substantial irradiation and is universally fatal. […] Presentation includes the rapid onset of nausea and vomiting followed by confusion, imbalance, fever, hypotension, seizure, coma, and death. […] Early signs of cutaneous damage include erythema, inflammation, desquamation, pigmentation changes, and epilation. Late signs of damage may include blood vessel injury, chronic edema, pain, ulceration, and blue discoloration. Ultimately, reactions ranging from dermal thinning to recurrent ulcerations, tissue necrosis, and invasive fibrosis may occur.

• #3 10 Signs of Radiation Sickness – Lancs Industries

  https://www.lancsindustries.com/blog/10-signs-of-radiation-sickness/

  Since the illness is caused by cellular death, and a breakdown of the bodys tissues and systems, the symptoms and side effects are not all that surprising. Here are 10 of the most common: Bleeding from the nose, gums, mouth and rectum. Ulcers in the mouth, esophagus, stomach and rectum or open sores on the skin. Bloody stool. Severe skin burns, including blisters. A sloughing off of the skin. Nausea and vomiting, potentially vomiting blood. Hair loss. Fever. Fatigue, fainting or mental fogginess. Inflammation of exposed areas (redness, swelling, bleeding). […] If you work around radiation and experience any of the following symptoms, you should notify your organizations radiation safety officer immediately and/or call 9-1-1 and let them know you may be experiencing radiation illness.

• #3

  https://flutrackers.com/forum/forum/health-humanitarian-issues/105241-recognizing-and-treating-radiation-sickness

  The initial signs and symptoms of treatable radiation sickness are usually nausea and vomiting. The amount of time between exposure and when these symptoms develop is an indicator of how much radiation a person has absorbed. After the first round of signs and symptoms, a person with radiation sickness may have a brief period with no apparent illness, followed by the onset of new, more serious symptoms. In general, the greater your radiation exposure, the more rapid and more severe your symptoms will be. […] If you have radiation sickness, you may receive additional medications or interventions to treat bacterial infections, headache, fever, diarrhea, nausea and vomiting, and dehydration. […] A person who has absorbed large doses of radiation (6 Gy or greater) has little chance of recovery. Depending on the severity of illness, death can occur within two days or two weeks.

• #3 Clinical manifestations, evaluation, and diagnosis of acute radiation exposure – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-evaluation-and-diagnosis-of-acute-radiation-exposure

  – Manifest ARS (21 to 60 days after exposure) — Manifest ARS follows a predictable pattern that generally begins with infection, anemia, and bleeding; followed by uncontrollable diarrhea, hypovolemia, and electrolyte disturbances; and finally, deteriorating mental status, cerebral edema, and overwhelming cardiovascular collapse. […] – Recovery phase — The recovery phase refers to the period after manifest ARS where the patient recovers from the acute exposure. The timing for recovery will depend on the severity of injury and affected organ system(s). […] Even after recovery from acute radiation injury, the patient remains at risk for chronic injury and long-term complications, such as the Delayed Effects of Acute Radiation Exposure (DEARE) that include pulmonary fibrosis and cataracts. Patients may also be at increased risk of developing myelodysplastic syndrome, various leukemias, solid tumors (eg, cancer of the thyroid, breast, and brain), and thyroid disease. Long-term effects are similar to those after therapeutic radiation.

• #3 Reddit – The heart of the internet

  https://www.reddit.com/r/explainlikeimfive/comments/5yry50/eli5why_do_you_get_better_for_a_few_days_after/

  „Once exposed, nausea and vomiting will begin almost immediately, and within a short space of time your tongue and eyes will swell, followed by the rest of your body. Youll feel weakened, as if the strength has been drained from you. If youve received a high dose of direct exposure – as in this scenario – your skin will blanche dark red within moments, a phenomenon often called nuclear sunburn. An hour or two after exposure, youll gain a pounding headache, a fever and diarrhoea, after which youll go into shock and pass out. […] After this initial bout of symptoms, theres often a latent period during which youll start to feel like youre recovering. The nausea will recede, along with some swelling, though other symptoms will remain. This latent period varies in duration from case to case, and of course it depends on the dose, but it can last a few days. Its cruel because it gives you hope, only to then get much, much worse. The vomiting and diarrhoea will return, along with delirium. An unstoppable, excruciating pain seethes through your body, from the skin down to your bones, and youll bleed from your nose, mouth and rectum. Your hair will fall out; your skin will tear easily, crack and blister, and then slowly turn black.”

• #4 Time Phases of Acute Radiation Syndrome (ARS) – Radiation Emergency Medical Management

  https://remm.hhs.gov/ars_timephases4.htm

  Acute Radiation Syndrome time phases resulting from 6-8 Gy radiation exposure […] Vomiting: Onset: Percent of victims who vomit at this dose: 100% […] Diarrhea: Heavy, Onset: 1-3 hours after exposure, Percent of victims with diarrhea at this dose: 10% at low end; at high end of dose range ~100% of victims affected […] Headache: Severe, Onset: 3-4 hours after exposure, Percent of victims with headache at this dose: 80% […] Body temperature: High fever, Percent of victims with fever at this dose: 100% […] Potential clinical effects: Anorexia, Fever, Malaise, weakness, Bleeding, infection, Epilation: hair is lost by day 11, Nausea, vomiting, Diarrhea: common by day 6-9; more severe with increased dose from exposure, Disorientation, Hypotension […] Lethality: Percent of victims who die at this dose: 50% beginning at 1-2 weeks

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