Effects of Whole-Body Irradiation From External Radiation or Internal Absorption
Phase of Syndrome | Feature | Dose Range (Gy)*, † | ||||
|---|---|---|---|---|---|---|
1–2 | 2–6 | 6–8 | 8–30 | > 30 | ||
Prodrome | Incidence of nausea and vomiting | 5–50% | 50–100% | 75–100% | 90–100% | 100% |
Time of onset of nausea and vomiting after exposure‡ | 2–6 hours | 1–2 hours | 10–60 minutes | < 10 minutes | Minutes | |
Duration of nausea and vomiting | < 24 hours | 24–48 hours | < 48 hours | < 48 hours | N/A (patients die in < 48 hours) | |
Severity and incidence of diarrhea | None | None to mild (< 10%) | Moderate to Severe (> 10%) | Severe (> 95%) | Severe (100%) | |
Time of onset of diarrhea after exposure | — | 3–8 hours | 1–3 hours | < 1 hour | < 1 hour | |
Severity and incidence of headache | Slight | Mild to moderate (50%) | Moderate (80%) | Severe (80–90%) | Severe (100%) | |
Time of onset of headache after exposure | — | 4–24 hours | 3–4 hours | 1–2 hours | < 1 hour | |
Severity of fever | Afebrile | Moderate increase | Moderate to severe | Severe | Severe | |
Incidence of fever | — | 10–100% | 100% | 100% | 100% | |
Time of onset of fever after exposure | — | 1–3 hours | < 1 hour | < 1 hour | < 1 hour | |
Central nervous system function | No impairment | Cognitive impairment for 6–20 hours | Cognitive impairment for > 24 hours | At higher doses, rapid incapacitation May have a lucid interval of several hours | Ataxia Seizures Tremor Lethargy | |
Latent period | No symptoms | 28–31 days | 7–28 days | < 7 days | None | None |
Overt illness | Clinical manifestations | Mild to moderate leukopenia Fatigue Weakness | Moderate to severe leukopenia Purpura Hemorrhage Infections Epilation after 3 Gy | Severe leukopenia High fever Diarrhea Vomiting Dizziness and disorientation Hypotension Electrolyte disturbance | Nausea Vomiting Severe diarrhea High fever Electrolyte disturbance Shock | N/A (patients die in < 48 hours) |
Dominant organ system syndrome | Hematopoietic | Hematopoietic | Gastrointestinal (mucosal cells) | Gastrointestinal (mucosal cells) | Central nervous system | |
Hospitalization | Outpatient observation | Recommended to necessary | Urgent | Palliative treatment (symptomatic only) | Palliative treatment (symptomatic only) | |
Acute mortality without medical care | 0–5% | 5–100% | 95–100% | 100% | 100% | |
Acute mortality with medical care | 0–5% | 5–50% | 50–100% | 100% | 100% | |
Death | 6–8 weeks | 4–6 weeks | 2–4 weeks | 2 days–2 weeks | 1–2 days | |
* 1 rad = 1 cGy; 100 rad = 1 Gy. | ||||||
† Whole-body irradiation of up to ~1 Gy is unlikely to cause any symptoms. | ||||||
‡ Although time to emesis is a rapid and inexpensive method for estimating radiation dose, it should be used with caution because it is imprecise and has a high false-positive rate. Additional information, such as lymphocyte counts and details of the potential for exposure, improve accuracy. | ||||||
Adapted from Military Medical Operations Armed Forces Radiobiology Research Institute: Medical Management of Radiological Casualties, edition 3. June 2010. | ||||||