Acute Radiation Syndrome- Treatment, Complications. Radio-dermatitis
Written by Anam Hussain
Acute Radiation Syndrome is defined as a combination of clinical syndromes occurring in stages during a period of hours to weeks, after exposure. Injury to various tissues and organs is expressed.
Management of a radiation casualty involves simultaneously managing severe immune system compromises and any resulting infectious complications. As well as preventing anaemia and haemorrhage cue to severe thrombocytopenia. Doses in the haemopoietic syndrome range are survivable and so the therapeutic goals is to lessen the severity of neutropenia and thrombocytopenia, whilst minimising and treating any infections.
Medical management of patients with ARS usually starts with activities targeted at treating infection complications. These activities can be divided into two groups:
- Prophylaxis
- Barrier/isolation
- Gut decontamination
- Antiviral/antifungal agents
- Pneuomocystis prophylaxis
- Early cytokine therapy
- Closure of wounds
- Avoiding invasive procedure
- Direct therapy for infections
- Culture specific antibiotics
- Leukopenia therapy
- Cytokine administration
- Patients exposed to radiation doses exceeding 2 Gy should be treated in isolated wards
- Moderate degree ARS casualties (Absorbed dose: 2-4 Gy): require 10-20 days of isolation
- Severe degree ARS casualties (Absorbed dose: >4Gy): require isolation from very beginning.
Other treatments:
Gut decontamination-
- A significant complication of immunosuppression from ARS is the development of sepsis
- Use of antibiotics along with the pathophysiological changes that occur in ARS, cause changes to normal gut flora and may cause many gastrointestinal pathogens to gain access to blood circulation (causing sepsis)
- Treatment: selective decontamination of drugs using poor absorbable, oral antibacterial drugs e.g. Quinolones
Fluids and electrolyte administration-
- Because nausea and vomiting during prodromal phases of ARS can lead to dehydration
Bone Marrow transplantation
- Is the main therapeutic approach to haemopoietic syndrome
- Marrow should be infused within first 3 days of radiation exposure
Treatment for radioactive induced diarrhoea
- Diarrhoea is associated with the prodromal and sub-acute phases of GI injury
- Most likely due to abnormalities regarding neurohormonal factors involved in GI motility and transport
- Anti-diarrhoeal and anti-secretory agents given
Cytokine administration
- Increases rate of haemopoietic recovery in patients
- Increases production of white blood cells
- Minimises extent and duration of radiation induced neutropenia hence minimises subsequent risk of infection