Radiation Sickness: Symptoms and Possible Treatment

Radiation sickness is rare in its full-blown form, but there are more everyday risks to be aware of. Find out all about this pathology.

Written and verified by the doctor Mariel Mendoza.

Last update: 15 March, 2023

Radiation sickness is the set of symptoms that occur as a result of exposure to high doses of ionizing radiation. In general, the exposure must be over a short period of time. It is also known as acute irradiation syndrome or radiotoxemia.

For radiation sickness to occur, the doses received must be high and belong to the penetrating radiation group. That is to say, those that have the capacity to reach the internal organs. When we say a short period of time, we mean only minutes in nuclear explosions or a few weeks in other circumstances.

The scientist Marie Curie died in 1934 as a result of radiotoxemia. She suffered from one of its most serious complications: medullary aplasia.

Clinical picture of radiation sickness

Radiation sickness develops in 4 clinical stages that have variable duration and intensity:

1. Prodromal
2. Latent
3. Manifest
4. Recovery or death

The probability of developing symptoms increases if the dose is higher than 0.7 grays. The cause of death, as will be discussed later, is associated with severe infections or destruction of the bone marrow. Dehydration with water and electrolyte imbalance and coma may also occur in the process.

When the dose exceeds or approaches 10 grais, it is potentially fatal within 2 to 4 weeks.

The severity of the consequences depends on the degree of exposure and the dose received. As well as on the part of the body that was exposed.

1. Prodromal phase of acute irradiation syndrome

The first symptoms of radiation sickness are usually the following:

• Diarrhea
• Headaches
• Lack of appetite
• Nausea and vomiting
• Skin rashes
• Tiredness and extreme fatigue

Swelling and edema, vertigo, tachycardia, irritability, and insomnia may also occur. These symptoms occur from minutes after exposure to several days or weeks later.

Radiation damage to the skin usually manifests as redness and swelling. There will be blistering and ulcers, as with heat burns.

This first phase tends to disappear within a week. Thus, it gives the false belief that there’s no longer any danger from radiation. However, it’s very likely that the same or new symptoms will occur some time later.

2. Latency phase of radiation sickness

During the latency phase there are usually no symptoms of radiation sickness or they tend to be very mild. It may last from the first week of exposure until 21 to 30 days later.

Symptoms will tend to return and worsen. Bone marrow cell death is occurring at this point in the process.

3. Overt clinical phase of radiation sickness

Subsequently, hair loss, fertility impairment and, most severely, involvement of the hematopoietic, gastrointestinal, cardiovascular and neurological systems may occur. Central nervous system and digestive signs usually include the following:

• Fatigue
• Loss of appetite
• Vomiting preceded by nausea
• Convulsions
• Coma

When there’s destruction of the bone marrow, hematopoietic syndrome occurs, characterized by pancytopenia or decrease of the three types of blood cells, with anemia (red blood cells), leukopenia (white blood cells) and thrombocytopenia (platelets).

Thrombocytopenia brings with it the risk of bleeding. Meanwhile, leukopenia raises the possibility of infections due to immunosuppression.

In severe cases there may be internal bleeding, loss of gastrointestinal motility, and severe immunosuppression.

4. Final phase

The critical phase of radiation therapy disease occurs around the second to seventh week after exposure. Here either recovery or death occurs.

There’s usually total bone marrow aplasia (manifested by pancytopenia), prolonged coma, loss of motility of the gastrointestinal tract, and spontaneous miscarriages and infertility.

The diagnosis is clinical and made by ruling out other conditions

The diagnosis of radiation sickness is clear when there’s a previous exposure event. It can occur after nuclear accidents (something very rare nowadays), but also as a consequence of prolonged treatments for cancer, such as breast cancer. It can even occur in work environments where nuclear energy is handled.

When there are burn-like lesions on the skin, without exposure to the sun, chemicals or any electrical current, radiation sickness should be suspected.

There’s no specific treatment for radiation sickness

Treatment is focused on resolving symptoms, so it must be individualized on a case-by-case basis. It’s usually focused on addressing infections, as well as injuries and burns, while maintaining hydration. Antibiotics, antiemetics, and sedatives are prescribed.

When there’s bone marrow involvement, treatments must be more intensive and include hematopoietic line stimulating factors. This is because the main cause of death in radiation sickness is internal bleeding due to lack of platelets and infections due to lack of white blood cells.

Plasma and blood transfusions, surgical intervention for burns, and, in some cases, protocols for radiation-induced leukemia may be required.

Bone marrow transplantation is an option. In contrast, in cases of infertility due to ovarian and testicular dysfunction, there’s no effective treatment.

A disease with long-term effects

Radiation sickness is very rare and is mostly caused by extreme situations, such as a nuclear explosion or accidents in nuclear power plants. However, there are milder consequences that occur in the context of everyday situations, such as cancer treatment or the performance of certain tasks.

To reach full radiation sickness, with all its phases, one would have to receive the equivalent of more than 18,000 chest X-rays in a short period of time.

The healing of the skin and bone marrow can take from weeks to years. In addition, the accumulation of radiation levels can increase the risk of cancer over a lifetime.