radiation poisoning acute and chronic poisoning,symptoms, management

1. RADIATION POISONING
1LMT
RADIATION
POISONING
Presented by
S.Nandhini

2. • Radiation is a form of energy whose sources are synthetic and
naturally occurring.
• Small quantities of radioactive materials occur naturally in the
environment (atmosphere, water, and food) and are referred to as
internal exposure.
• External exposure results from sunlight radiation and from
synthetic and naturally occurring radioactive materials.
• Radiation poisoning is also known as radiation sickness
• Radiation sickness is illness and symptoms resulting from
excessive exposure to ionizing radiation.
2LMT

3. • Radiation is often categorized as either ionizing or non-
ionizing depending on the energy of the radiated particles
LMT 3

4. • IONIZING RADIATION -Gamma rays, X-rays and the higher
energy range of ultraviolet light constitute the ionizing part of
the electromagnetic spectrum.
• NON IONIZING RADIATION -The lower-energy, longer-
wavelength part of the spectrum including visible light, infrared
light, microwaves and radio waves is non-ionizing; its main
effect when interacting with tissue is heating.
• This type of radiation only damages cells if the intensity is high
enough to cause excessive heating. Ultraviolet radiation has
some features of both ionizing and non-ionizing radiation.
LMT 4

5. IONIZING RADIATION
• Ionizing radiation induces somatic changes in cells and tissues
by displacing electrons from their atomic nuclei, resulting in
the intracellular ionization of molecules.
• Depending on the dose and length of exposure, the effects can
be immediate, chronic, or delayed. The most important targets
are the DNA-molecules, where direct or indirect actions of
radiation could result in lesions, such as base damage, single-
strand breaks and double-strand breaks.
5LMT

6. • Double-strand breaks are considered the most serious DNA-
lesions, since they can result in the cleavage of chromatin and
might not be successfully repaired by the cell. The occurrence
of DNA-lesions and, especially, of double-strand breaks will
increase with increasing radiation exposure and will lead to a
higher risk of cell death
• Thus, reversible or irreversible DNA changes are induced,
initiating a series of events that culminate in the production of a
mutagenic response, a carcinogenic response, the inhibition of
cell replication, or cell death.
LMT 6

7. LMT 7

8. SOURCE OF IONIZING RADIATION
 Medical Sources
• The largest source of medical exposure, when averaged over all
individuals, is from diagnostic x-rays, including both chest or limb x-
rays and dental x-rays.
• Nuclear medicine also includes in treatment of disease. Some
examples are cobalt irradiation for the treatment of cancers, or the
injection of radioactive iodine which concentrates in the thyroid for
treatment of Graves’ disease.
• High-energy diagnostic or therapeutic X-rays, used in the treatment
of cancer.
LMT 8

9.  Occupational exposure involves variable amounts of
radioactivity from nuclear reactors, linear accelerators, and
sealed cesium, americium, and cobalt sources used in
therapeutic instruments and detectors.
 Natural Sources of Radiation
• Peoples are exposed to X rays and Gamma rays from cosmic rays
from our solar system and radioactive elements normally present
in the soil
• Radium and radon gas are naturally occurring hazardous
isotopes embedded in the Earth’s crust
LMT 9

10. Symptoms of Radiation Poisoning
SKIN CHANGES: Cutaneous radiation syndrome (CRS) refers to
the skin symptoms of radiation exposure. Within a few hours after
irradiation, a transient and inconsistent redness(associated with
itching) can occur. Then, a latent phase may occur and last from a few
days up to several weeks, when intense reddening, blistering, and
ulceration of the irradiated site are visible.
LMT 10

11. LMT 11
Nausea and vomiting Hair loss
FatigueSpontaneous bleeding

12. Moderate radiation sickness
With an acute absorbed dose
of 2 to 3.5 Gy
Nausea and vomiting within
12 to 24 hours ,Fever
Hair loss ,Infections
Vomiting blood ,Bloody stool
Poor wound healing . It can be
fatal to those most sensitive to
radiation exposure.
Severe radiation sickness An absorbed dose of 3.5 to 5.5
Gy
Nausea and vomiting less than
one hour after exposure to
radiation
Diarrhea ,High fever
Severe radiation sickness is
fatal about half the time.
Very severe radiation sickness
Absorbed dose greater than
5.5 to 8 Gy
Nausea and vomiting less than
30 minutes after expo
sure to radiation
Dizziness ,Disorientation
hypotension
Very severe radiation sickness
is often fatal
12

13. UV RADIATION
• Prolonged human exposure to solar UV radiation
may result in acute and chronic health effects
on the skin, eye and immune system.
• UV rays (e.g., from sun exposure) is mediated principally by the
generation of reactive oxygen species and the interruption of
melanin production.
• Sunburn (erythema) is the best-known acute effect of excessive
UV radiation exposure.
• Another long-term effect is an inflammatory reaction of the eye.
In the most serious cases, skin cancer and cataracts can occur.LMT 13

14. EFFECT OF UV RAYS
LMT 14
Ultraviolet (UV) photons harm the DNA molecules of living
organisms in different ways. In one common damage event,
adjacent bases bond with each other, instead of across the
“ladder.” This makes a bulge, and the distorted DNA molecule does
not function properly.

15. • SOURCE: Sunlight is the main source of UV rays. Tanning lamps
and beds are also sources of UV rays.
• Fluorescent lamps ,Mercury vapour lamp ,Halogen lamps
• There are 3 main types of UV rays:
• UVA rays age skin cells and can damage their DNA. Most tanning
beds give off large amounts of UVA, which has been found to
increase skin cancer risk.
• UVB rays have slightly more energy than UVA rays. They can
cause sunburns and most skin cancers.
• UVC rays have more energy than the other types of UV rays, but
they don’t get through sunlight. They are not normally a cause of
skin cancer.
LMT 15

16. Reactions To Excessive Sunlight Clinical Effects
General Dermatologic Dermatoheliosis – aging of the skin due
to chronic exposure to sunlight
Elastosis – yellow discoloration of skin
with accompanying small nodules
Wrinkling, hyperpigmentation, atrophy
and dermatitis
Actinic keratoses Precancerous keratotic lesions, appear
after many years of exposure to
UV rays
Squamous/basal cell
carcinoma
Occurs more commonly in light-skinned
individuals exposed to extensive
UV rays during adolescence
Malignant melanomas prolonged exposure to UV light
Photosensitive
reactions
Erythema and erythema multiform
lesions; urticaria, dermatitis, bullae;
thickened, scaling patches
16LMT

17. LMT 17

18. • First-degree burns are generally red, sensitive, and moist. The
absence of blisters and blanching of the skin with application of
light pressure are characteristic features.
• Second-degree burns are classified as superficial intermediate, or
deep, with partial skin loss. The presence of erythematous blisters
with exudate is typical of second-degree burns
18LMT

19. • Third-degree burns involve deep dermal, whole skin loss. The
skin appears black, charred, and leathery. Subdermal vessels do
not blanch with applied pressure and the areas exposed are
generally anesthetic or insensitive to pain stimuli.
• fourth-degree burns involve deep tissue and structure loss.
Hypertrophic scars and chronic granulations develop unless skin
grafting treatment is instituted.
LMT 19

20. UV effects on eye
• The eyes are particularly sensitive to UV radiation. Even a short
exposure of a few seconds can result in a painful, but temporary
condition known as photokeratitis and conjunctivitis.
• which becomes swollen and produces a watery discharge. It
causes discomfort rather than pain and does not usually affect
vision
LMT 20

21. PREVENTION
• Wear a sunscreen that has an SPF of at least 30 and says "broad-
spectrum" on the label, which means that it protects against the sun's
UVA and UVB rays..
• Limit sun exposure between 10 a.m. to 2 p.m.
• Wear sunglasses, a hat, and protective clothing.
• Avoid unnecessary exposure to radiation.
• Persons working in radiation hazard areas should wear badges to
measure their exposure level.
• Protective shields should always be placed over the parts of the body
not being treated or studied during x-ray imaging /radiation therapy.LMT 21

22. Non-ionizing
radiation
LMT 22

23. • Types of non –ionising radiation:
Optical Radiation
- Ultraviolet,
- Infrared and
- Visible (including lasers)
Radiofrequency Radiation
- Microwaves
- Radiofrequency
LMT 23

24. IR Sources and effects
• SOURCES: most are thermal sources (plasma
torches, halogen lamps)
• Target Organs: skin and eyes
• Can damage – cornea, iris, retina and lens of
the eye
• Skin: heats/burn surface of the
skin and tissues
02:08:09 AM 24

25. Microwave Sources
Television 25
Radar
Microwave oven
Traffic controller

26. Biological Effects [Microwaves]
• Primarily thermal effects
• cataracts
• CNS, biochemical changes
• Secondary problems (pace-makers, etc.)
• The latter are also capable of disrupting the normal
function of electronic medical devices such as
subcutaneously implanted cardiac pacemakers and
monitors.
02:08:09 AM 26

27. DIAGNOSIS
• The most useful and rapid method for clinical assessment of the
degree of radiation exposure, especially ionizing radiation, is
determination of the patient’s total blood lymphocyte count.
 Serial determinations are performed every 6 h for atleast 48 h. A
50% fall in total lymphocytes every 24 h for 2 days is indicative
of a potentially lethal injury.
• A device called a dosimeter can measure the absorbed dose of
radiation but only if it was exposed to the same radiation event as
the affected person.
LMT 27

28. DOSIMETER.
LMT 28

29. MANAGEMENT
LMT 29

30. GOALS
• The treatment goals for radiation sickness are
to prevent further radioactive contamination;
treat life-threatening injuries, such as from
burns and trauma; reduce symptoms; and
manage pain.
LMT 30

31. • Decontamination
• Decontamination prevents further distribution of radioactive
materials and lowers the risk of internal contamination from
inhalation, ingestion or open wounds
• Removing clothing and shoes eliminates
about 90 percent of external contamination.
• Gently washing with water and soap removes additional
radiation particles from the skin.
LMT 31
.

32. • Treatment for internal contamination
• Some treatments may reduce damage to internal organs caused
by radioactive particles. These treatments include the following:
• Potassium iodide.
• Prussian blue
• Diethylenetriamine penta acetic acid.
• Filgrastim
LMT 32

33. Potassium iodide (Thyroshield, Iosat).
• This is a non radioactive form of iodine. is most
effective if taken within a day of exposure
• can help block radioactive iodine from being absorbed by the thyroid
gland
• Adults dose- 130 mg (OD130 mg OR BD 65 mg )
• Side effects -stomach upset, allergic reactions and
inflammation of the salivary glands
LMT 33

34. • Prussian blue (Radiogardase).
• This type of dye binds to particles of radioactive elements
known as cesium and thallium.
• This treatment speeds up the elimination of the radioactive
particles and reduces the amount of radiation cells may absorb.
• It reduces the biological half-life of cesium from 110 days to 30
days.
• It reduces the biological half-life of
thallium from 8 days to 3 days
• Dose – 500 mg capsule.
LMT 34

35. • Diethylenetriamine pentaacetic acid (DTPA).
• Ca-DTPA and Zn - DTPA
• DTPA binds to particles of the radioactive elements
plutonium, and curium.
• The radioactive particles pass out of the body
in urine, thereby reducing the amount
of radiation absorbed.
LMT 35

36. • Treatment for damaged bone marrow
• A protein called granulocyte colony-stimulating factor, which
promotes the growth of white blood cells, may counter the effect
of radiation sickness on bone marrow.
• Treatment with this protein-based medication, which includes
filgrastim (Neupogen), and pegfilgrastim (Neulasta), may
increase white blood cell production and help prevent
subsequent infections.
• 10 mcg/kg SC as a single daily injection for patients exposed to
myelosuppressive doses of radiation
• Administer as soon as possible after suspected or confirmed
LMT 36

37. Filgrastim: Must follow the labelling instruction before
administaration
 Do not shake. Shaking will cause damage the filgrastim.
 Before using the drug take it from refrigerator & keep it room
temp for 30 min.
 Choose new site for injection every time.
 Discard the unused part of drug
 up to 2 weeks, by subcutaneous injection
LMT 37

38. LMT 38