What is the treatment for radiation poisoning?

Treatment for Radiation Poisoning

The treatment of radiation poisoning requires a comprehensive approach focused on supportive care, infection prevention, and specific countermeasures based on the type and severity of radiation exposure. 1

Initial Assessment and Triage

• Determine radiation dose based on:

  • Time to onset of vomiting (earlier onset indicates higher exposure)
  • Lymphocyte count decline rate (faster decline indicates higher exposure)
  • Clinical symptoms
  • Chromosome analysis (dicentric count) for dose estimation 2

• Categorize exposure severity:

  • Mild: <0.7 Gy
  • Moderate: 0.7-4 Gy (hematopoietic syndrome)
  • Severe: 4-10 Gy (gastrointestinal syndrome)
  • Very severe: >10 Gy (cardiovascular/CNS syndrome, usually fatal) 1, 3

Immediate Interventions

1. For internal contamination with radioactive materials:

   • Administer chelating agents within 24 hours of exposure:
     • Ca-DTPA: 1g IV for adults (14mg/kg for children) as initial dose for plutonium, americium, or curium contamination 4
     • Switch to Zn-DTPA for maintenance therapy after initial dose 4
     • Dimercaprol (BAL) or penicillamine for polonium-210 contamination 2
     • Prussian blue for cesium or thallium contamination 5
     • Potassium iodide for radioiodine exposure (especially important for children) 1

2. For external contamination:

   • Remove clothing and wash skin with soap and water
   • Treat any associated trauma or burns 1

Management of Acute Radiation Syndrome

Supportive Care

• Fluid and electrolyte replacement
• Antiemetic agents for nausea and vomiting
• Antidiarrheal agents for gastrointestinal symptoms
• Analgesics for pain management
• Topical treatments for radiation burns 1

Infection Prevention and Management

• For neutropenic patients (ANC <0.500 × 10^9 cells/L):

  • Prophylactic antimicrobials: fluoroquinolone with streptococcal coverage (or fluoroquinolone plus penicillin)
  • Antiviral prophylaxis: acyclovir or equivalent
  • Antifungal prophylaxis: fluconazole 1

• For neutropenic fever:

  • Discontinue fluoroquinolone
  • Initiate broad-spectrum antibiotics with coverage for Pseudomonas aeruginosa 1

Hematologic Support

• Transfusion with leukoreduced, irradiated blood products:

  • Platelets for thrombocytopenia
  • Red blood cells for anemia 1

• Growth factors consideration:

  • Granulocyte colony-stimulating factors may be beneficial for neutropenia 1

Stem Cell Transplantation

• Consider for patients with exposure of 7-10 Gy without significant burns or other major organ toxicity
• Not recommended for patients with granulocyte count >0.500 × 10^9 cells/L and platelet count >100 × 10^9 cells/L at 6 days post-exposure 1

Special Considerations

Gastrointestinal Management

• Avoid instrumentation of GI tract when possible (mucosa is fragile)
• Provide prophylaxis against GI ulceration
• Maintain adequate hydration
• Consider temporary lactose avoidance 1, 6

Comfort Care

• For patients with exposure >10 Gy, focus on comfort measures rather than aggressive treatment
• Provide psychological support for patients and families 1

Monitoring and Follow-up

• Serial blood counts to monitor bone marrow function
• Regular monitoring of serum electrolytes and essential metals
• Radioactivity measurements in blood, urine, and fecal samples
• Long-term monitoring for delayed effects of radiation exposure 1, 7

Pitfalls and Caveats

1. Do not delay treatment while waiting for exact dose estimation - begin supportive care immediately based on clinical presentation 1

2. Avoid prophylactic antiemetics initially as time to vomiting onset helps with dose estimation 1

3. Be aware of delayed effects - even after successful mitigation of acute radiation syndrome, patients may develop delayed complications requiring long-term monitoring 7

4. Recognize that radiation burns may appear delayed - skin manifestations can develop days to weeks after exposure 1

5. Ensure healthcare worker safety - use appropriate personal protective equipment when treating contaminated patients 1