Management of Acute Radiation Syndromes (ARS)

Hematopoietic

G-CSF (granulocyte-colony stimulating factor) or GM-CSF (granulocyte-macrophage colony-stimulating factor) when absolute neutrophil count (ANC) < 0.5 × 10⁹ cells/L (↑)

Erythropoietic stimulating agents in patients with prolonged anemia (↓)

Hematopoietic stem cells after failure of 2 to 3 weeks of cytokine treatment to induce recovery from marrow aplasia in the absence of non-hematopoietic organ failure (↓)

Gastrointestinal

Fluoroquinolone or similar antibiotic from 2 to 4 days after radiation exposure (↓)

Bowel decontamination and parenteral antibiotics when indicated (↓)

Prophylactic serotonin receptor antagonist when suspected exposure is >2 Gy (↓)

Cutaneous

Topical class II–III corticosteroids, topical antibiotics, and topical antihistamines applied to radiation burns, ulcer, or blisters (↑)

Systemic corticosteroids for radiation burns, ulcers, or necrosis in the absence of a specific indication for systemic corticosteroid use (strong against the practice)

Surgical excision and graft of radiation ulcers or localized necrosis with intractable pain (↑)

Neurovascular

Critical care

Fluid, electrolyte replacement therapy, and sedatives in patients with significant burns, hypovolemia, and/or shock (↑)

Mechanical ventilation with a lung-protective strategy in patients with acute respiratory failure (↑)

Selective oropharyngeal decontamination or selective decontamination of the digestive tract (↓)

Maintain average blood glucose of 140 to 180 mg/dL (7.8 to 10 mmol/L) for majority of critical care patients (↓)

H2 blocker or proton pump inhibitor (↓)