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Overview |
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Definition |
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Ionizing radiation is either electromagnetic or accelerated atomic
particulate. Radiation damage is the observable or measurable insult to body
form or function. Radiation is measured in several ways; by rads, as tissue's
absorption of energy, and by rems, a radiation dose factored by biologic
effectiveness for a particular tissue type (1 rad = 100 ergs of energy absorbed
by 1g of tissue; 100 rads = 1 gray [gy]; 1 rem = 1 sievert [sv]). Radiation
damage may beget carcinogenic or teratogenic effects, and may cause acute or
chronic syndromes. Acute radiation sickness presents within 24 hours of
exposure, marked by hematopoietic syndrome (200 to 1,000 rads) with death rate
up to 80%, or neurovascular syndrome (over 5,000 rads) with a 100% death rate.
Chronic radiation syndrome includes a myriad of symptoms occurring over an
extended time. |
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Etiology |
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Damage occurs when radiation interacts with oxygen, causing superoxide,
hydrogen peroxide, or hydroxyl radicals to form. These radicals are capable of
damaging or breaking both single and double strands of DNA, both of which can
result in cell death. |
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Risk Factors |
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- Degree of damage is dose dependent, with the young more susceptible
- Substances that enhance the cytotoxic effects of radiation including
chemotherapy, antibiotics
- Prenatal exposure
- Exposure to more than maximum U.S. permissible dose of 50
mSv
- Human-made products or substances, such as X-ray imaging, radioactive
material in smoke detectors, nuclear power, or fallout from atomic
weapons
- Radiation therapy
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Signs and Symptoms |
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- Acute effects primarily seen in renewing (quickly dividing cell)
tissue—skin, small intestine, rectum, and bladder,
vaginal, and oropharyngeal mucosa
- Late (months or years) appearance—ulceration,
necrosis, fibrosis, fistula formation, degenerative changes, blindness, spinal
cord transsection
- Radiation syndrome (whole body, large
dose)—malaise, anorexia, nausea, vomiting, diarrhea,
sweating, fever, headache; with hematologic (hemorrhage), gastrointestinal
(mucosal damage, secondary infection), neurologic, cardiovascular, and pulmonary
complications; possibly death
- Central nervous system—Lhermitte's sign,
leukoencephalopathy
- Kidney—hypertension, anemia, edema,
proteinuria
- Liver—fatigue, abdominal pain
- Enterocolitis, coloproctitis—diarrhea,
nausea, tenesmus, rectal bleeding, abdominal cramping, telangiectasis, mucosal
ulceration, fatal dysentery-type syndrome, secondary malignancy
- Cranial—hypothalamic-pituitary dysfunction;
poor linear growth in children
- Skin—erythema, moist and dry desquamation,
epilation, necrosis, fibrosis of underlying tissue
- Cardiac—pericarditis
- Pulmonary—pulmonitis, pulmonary fibrosis, cor
pulmonale, respiratory failure
- Eye—microscopic posterior polar opacity;
cataracts
- Gonadal dysfunction
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Differential
Diagnosis |
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Specific sites of damage may resemble other diseases in that location (e.g.,
late intestinal damage resembles Crohn's disease) |
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Diagnosis |
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Physical Examination |
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Catastrophic radiation exposure (atomic bomb, nuclear accident) needs quick
evaluation of dose. History and physical findings help determine specific site
of radiation damage. Examination of oral mucosa indicates need to adjust
fraction size or delay treatment to allow cell
reconstitution. |
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Laboratory Tests |
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- Radioactive measurements identify particular isotope and
dose
- Lymphocyte count indicates need and degree of treatment
required
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Pathology/Pathophysiology |
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- Stem cells survival—crucial to
recovery
- Lymphocyte destruction (whole body
radiation—80% die immediately; localized
radiation—decreases number of circulating lymphocytes)
and subsequent depressed immune system
- Leukopenia and thrombocytopenia from hematopoietic cell
death
- Mutagenesis—dependent on type of radiation;
somatic mutations may lead to tumors
- Quickly dividing cells (e.g., hematopoietic system, epidermis,
intestinal epithelium, oral mucosa)—more sensitive to
damage, less capable of cell replacement
- Slower dividing cells—more able to repair
potentially lethal damage
- Late effects—possibly from vasculoconnective
tissue effects of damage on capillaries and venules of organs; from endothelial
cells; or from repeated depletion of target cell-renewing tissue, exhausting its
capacity to renew and causing permanent tissue failure
- Kidneys—decreased glomerular infiltration,
endothelial cell swelling, decreased parenchymal cells, vascular occlusion,
tubular dystrophy
- Liver—ascites; alkaline phosphatase and
transaminases elevation
- Intestine—epithelial cell death, denuding of
intestinal villi; ileal mucosa damage reduces bile acid reabsorption, causing
colonic water absorption and diarrhea
- Lungs—immediate injury to alveolar type II
pneumocytes
- Skin—upper dermis inflammation infiltrated
with granulocytes, macrophages, eosinophils, plasma cells, lymphocytes; hair
loss
- Oral mucosa—cell cycle time decreases,
proliferation increases
- Cranial—decreased growth hormone in
children
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Imaging |
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- Barium radiographic studies—reveal mucosal
edema, dilation or separation of intestinal loops, carcinoma
- Colonoscopy—helps differentiate
diagnosis
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Treatment Options |
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Treatment Strategy |
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Treatment is dependent on the type of radiation damage. Decontamination is
essential, if warranted. Fluids, RBC, WBC, and platelet transfusion if
warranted. |
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Drug Therapies |
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- Diarrhea, proctitis, sigmoiditis—low-fiber
diet and antidiarrhea drug (e.g., loperamide); sedation, antispasmodics, topical
analgesics, cholestyramine (4 to 8 g/d for salt malabsorption)
- Cranial radiation— exogenous growth hormone
therapy for children
- Hematologic—antibiotics for infection;
granulocyte and platelet transfusion; intravenous fluids for dehydration and
electrolyte loss; colony stimulating factors; interleukin; bone marrow
transplantation
- Intestinal stasis from enteritis with bacterial
overgrowth—broad-spectrum antibiotics; total parenteral
nutrition enhances therapeutic results
- Rectocolitis—sulfasalazine, steroid, or
sucralfate enemas
- Skin desquamation, ulceration—cleansing;
lanolin and dressings
- Pneumonitis and
pericarditis—glucocorticoids
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Surgical Procedures |
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- Endoscopic cauterization for bleeding from rectal mucosal
telangiectasis
- Endoscopic dilation of fistulas and strictures
- Some intestinal complications must be treated surgically, but this
often results in further morbidity
- Resection of necrotic tissue with
grafting
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Complementary and Alternative
Therapies |
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Nutrients and herbs may help prevent or minimize radiation damage as well as
enhance recovery. Homeopathy may be beneficial in resolving acute or long-term
sequelae. |
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Nutrition |
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- A whole-foods diet that emphasizes fresh fruits and vegetables, whole
grains, legumes, and anti-inflammatory fats (i.e., cold-water fish, nuts, and
seeds) provides essential nutrients for healing. Avoid pro-inflammatory and
nutrient-poor foods such as caffeine, alcohol, sugar, saturated fats (i.e.,
animal products), refined foods, and additives.
- Vitamin C (1,000 mg tid to qid), vitamin E (400 IU bid to tid),
coenzyme Q10 (100 mg bid to tid), and melatonin (2 to 10 mg/day) provide
antioxidant protection.
- Glutathione (500 mg bid) promotes detoxification activity and
antioxidant protection. N-acetylcysteine (200 mg tid) and selenium (200 mcg/day)
are precursors to glutathione.
- Vitamin A (10,000 IU/day) or beta carotene (25,000 IU/day) and zinc
(30 mg/day) protect mucosal membranes. L-glutamine (3 to 10 g tid) protects
intestinal mucosa.
- Bromelain (250 to 500 mg between meals) is a proteolytic enzyme that
decreases inflammation. Use with turmeric (Curcuma longa, 500 mg qid) to
potentiate effects.
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Herbs |
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Herbs may be used as dried extracts (pills, capsules, or tablets), teas, or
tinctures (alcohol extraction, unless otherwise noted). Dose is 1 heaping tsp.
herb/cup water steeped for 10 minutes (roots need 20 minutes).
- Rutin (100 mg to 200 mg one to three times/day) provides antioxidant
protection.
- Milk thistle (Silybum marianum), 100 mg tid, is
hepatoprotective and antioxidant.
- Gotu kola (Centella asiatica), 1,000 mg qid or standardized
extract 60 mg bid, may prevent fibrosis.
For acute effects:
- Marshmallow root (Althaea officinalis) tea to soothe inflamed
mucosal tissues. Soak 1 heaping tbsp. of root in 1 quart of cold water
overnight. Strain and drink throughout the day. May be taken
long-term.
- Equal parts of coneflower (Echinacea purpurea), goldenseal
(Hydrastis canadensis), marigold (Calendula officinalis), licorice
root (Glycyrrhiza glabra), plantain (Plantago lanceolata), and
wild lettuce (Lactuca virosa) provide immune support, enhance healing,
and relieve pain. Take 30 to 60 drops qid for six to eight weeks. Licorice root
may exacerbate hypertension, but also heals ulcers, increases IgA in the gut.
- For long-term use, combine goldenseal, licorice root, marigold, red
clover (Trifolium pratense), wild yam (Dioscorea villosa), and
meadowsweet (Filipendula ulmaria). Take 30 to 60 drops bid to tid.
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Homeopathy |
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An experienced homeopath would consider the individual's constitution. Acute
dose is three to five pellets of 12X to 30C every one to four hours until
symptoms resolve. Use Radium bromatum specifically for radiation
poisoning, especially followed by arthritic complaints. |
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Physical Medicine |
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External wash of coneflower, goldenseal, comfrey root (Symphytum
officinalis), and sea buckthorn (Hippophae rhamnoides) facilitates
healing and minimizes infection. Vitamin E oil applied topically twice daily,
and Aloe vera extract applied as needed to help
healing. |
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Patient Monitoring |
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Close monitoring and regular follow-up improves treatment outcome. Blood
levels at frequent intervals, vigilance for
sepsis. |
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Other
Considerations |
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Prevention |
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- Use lowest possible therapeutic dose and fractionate for optimal
treatment and minimal damage (tumor specific)
- Radiation induces tumor necrosis factor and causes interleukin-1 to be
released—both may be radioprotective
- Recently tested radioprotectant chemicals (e.g., sulfhydryl compounds,
WR-2721)—reduce life span of free radicals, decreasing
damage
- Dactinomycin—inhibits sublethal
damage
- Intestinal and kidney shielding by biodegradable mesh reduces
collateral damage to those areas
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Complications/Sequelae |
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- Malignancies, leukemia
- Liver irradiation with partial hepatectomy can cause hepatic
failure
- Radiation to fractured bone causes deformity
- Sterility
- Fibrosis of lung, liver,
kidney
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Prognosis |
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- Related to dose
- Correlated to prompt, appropriate treatment
- Must monitor for long-term
complications
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Pregnancy |
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- Prenatal exposure—fetal death, gross
malformations, cancer, mental retardation, lower IQ
- Permanent sterilization, ovarian failure, and amenorrhea
possible
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References |
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1998. |
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Copyright © 2000 Integrative Medicine
Communications This publication contains
information relating to general principles
of medical care that should not in any event be construed as specific
instructions for individual patients. The publisher does not accept any
responsibility for the accuracy of the information or the consequences arising
from the application, use, or misuse of any of the information contained herein,
including any injury and/or damage to any person or property as a matter of
product liability, negligence, or otherwise. No warranty, expressed or implied,
is made in regard to the contents of this material. No claims or endorsements
are made for any drugs or compounds currently marketed or in investigative use.
The reader is advised to check product information (including package inserts)
for changes and new information regarding dosage, precautions, warnings,
interactions, and contraindications before administering any drug, herb, or
supplement discussed herein. | |