Radiation Damage - home health advice

Overview
Definition

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.
Etiology

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.
Risk Factors

* 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

Signs and Symptoms

* 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

Differential Diagnosis

Specific sites of damage may resemble other diseases in that location (e.g., late intestinal damage resembles Crohn's disease)
Diagnosis
Physical Examination

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.
Laboratory Tests

* Radioactive measurements identify particular isotope and dose
* Lymphocyte count indicates need and degree of treatment required

Pathology/Pathophysiology

* 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

Imaging

* Barium radiographic studies reveal mucosal edema, dilation or separation of intestinal loops, carcinoma
* Colonoscopy helps differentiate diagnosis

Treatment Options
Treatment Strategy

Treatment is dependent on the type of radiation damage. Decontamination is essential, if warranted. Fluids, RBC, WBC, and platelet transfusion if warranted.
Drug Therapies

* 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

Surgical Procedures

* 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

Complementary and Alternative Therapies

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.
Nutrition

* 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.

Herbs

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.

Homeopathy

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.
Physical Medicine

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.
Patient Monitoring

Close monitoring and regular follow-up improves treatment outcome. Blood levels at frequent intervals, vigilance for sepsis.
Other Considerations
Prevention

* 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

Complications/Sequelae

* Malignancies, leukemia
* Liver irradiation with partial hepatectomy can cause hepatic failure
* Radiation to fractured bone causes deformity
* Sterility
* Fibrosis of lung, liver, kidney

Prognosis

* Related to dose
* Correlated to prompt, appropriate treatment
* Must monitor for long-term complications

Pregnancy

* Prenatal exposure fetal death, gross malformations, cancer, mental retardation, lower IQ
* Permanent sterilization, ovarian failure, and amenorrhea possible

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