about radiation posioning and their treatment

1. RADIATION POISONING
D.B.sowmya sri
Y16PHD0102
IV/VI PHARM.D

2. Radiology logo

3. Radiation: The emission of energy as electromagnetic waves or
as moving subatomic particles, especially high-energy particles
which cause ionization.
• 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.

4.  Radiation poisoning is also known as radiation sickness (OR)
acute radiation syndrome (OR) radiation toxicity.
Definition: Radiation sickness is illness and symptoms resulting
from excessive exposure to ionizing radiation.
• Radiation is often categorized as either ionizing or non-
ionizing depending on the energy of the radiated particles
 Ionizing radiation: radiation that has enough energy to
remove electrons from atoms which convert into ions in form
of particles or rays( gamma rays , X- rays)
 Non-ionizing radiation: radiation that gives off enough
energy to make atoms vibrate, however not enough energy to
remove electrons (visible light, radio waves, micro waves).

6. 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.
• 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.

7. • 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.

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.
• 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.

9. • 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
• An accident at a nuclear industrial facility
• An attack on a nuclear industrial facility
• Detonation of a small radioactive device
• Detonation of a conventional explosive device that disperses
radioactive material (dirty bomb)
• Detonation of a standard nuclear weapon

10. Signs and symptoms of radiation poisoning:
Classically acute radiation syndrome is divided into three main
presentations:
• hematopoietic- aplastic anemia
• Gastrointestinal- nausea
vomiting
loss of appetite and
abdominal pain
• neurological/vascular- dizziness
headache
decreased level of consciousness
(occurring within minutes to a few hours)

11. 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.
• However, very large skin doses can cause permanent hair loss,
damaged sebaceous and sweat glands, atrophy, fibrosis
(mostly keloids), decreased or increased skin pigmentation,
and ulceration or necrosis of the exposed tissue
• Desquamation of the skin also can occur when affected with
beta-particles.

12. Keloids

13. Skin changes Hair loss
Spontaneous
bleeding

15. 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.

17. 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 lamp
• 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.

19. Dermatoheliosis elastosis
Actinic keratosis Erythema

21. • 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.
• Third-degree burns involve deep dermal, whole skin loss. The
skin appears black, charred, and leathery. Sub dermal 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.

22. 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 photo keratitis and
conjunctivitis.
• which becomes swollen and produces a watery discharge. It
causes discomfort rather than pain and does not usually affect
vision

23. Non-ionizing radiation
Types of non –ionizing radiation:
Optical Radiation - Ultraviolet,
Infrared and
Visible (including lasers)
Radiofrequency Radiation - Microwaves
Radio frequency

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
Biological Effects [Microwaves]
• Primarily thermal effects
• cataracts ,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.

25.  Uses:
• Urography
• Angiography
• Contrast radiography of GI tract
• Myelography
• Lymphography
• Magnetic resonance imaging
• Cholecystography , cholangiography

26. DIAGNOSIS
• Total blood lymphocyte count.
• Serial determinations are performed every 6 h for at least 48 h. A 50% fall
in total lymphocytes every 24 h for 2 days is indicative of a potentially
lethal injury.
• C-reactive protein (CRP) level: CRP increases with radiation dose; levels
show promise to discriminate between minimally and heavily exposed
patients.
• Blood citrulline level: Decreasing citrulline levels indicate GI damage.
• Blood fms-related tyrosine kinase-3 (FLT-3) ligand levels: FLT-3 is a
marker for hematopoietic damage.
• Interleukin-6: This marker of inflammation is increased at higher radiation
doses.
• Quantitative granulocyte colony-stimulating factor (G-CSF) test: Levels are
increased at higher radiation doses.
• Cytogenetic studies with over dispersion index: These studies are used to
evaluate for partial body exposure

27. • 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.

28. 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.

29. Shelter in place: If you're advised to stay where you are,
whether you're at home or work or elsewhere, do the following:
• Close and lock all doors and windows.
• Turn off fans, air conditioners and heating units that bring air
in from outside.
• Close fireplace dampers.
• Bring pets indoors.
• Move to an inner room or basement.
• Stay tuned to your emergency response network or local news.
• Stay put for at least 24 hours.

30. Management
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.
 Minimization of health care worker radiation exposure
and contamination
 Treatment of external and internal contamination
 Sometimes specific measures for particular radionuclides
 Precautions for and treatment of compromised immune
system
 Minimize inflammatory response
 Supportive care

31. External Decontamination :
• Decontamination prevents further distribution of radioactive
materials and lowers the risk of internal contamination from
inhalation, ingestion or open wounds
• Decontaminating wounds before decontaminating intact skin
• Cleaning the most contaminated areas first
• Using a radiation survey meter to monitor progress of
decontamination
• Removing clothing and shoes eliminates about 90 percent of
external contamination.
• Gently washing with water and soap removes additional
radiation particles from the skin.
Decontamination

32. Internal decontamination:
• Some treatments may reduce damage to internal organs
caused by radioactive particles.
• Ingested radioactive material should be removed promptly by
induced vomiting or lavage if exposure is recent.
• Frequent mouth rinsing with saline or dilute hydrogen
peroxide is indicated for oral contamination.
• Exposed eyes should be decontaminated by directing a stream
of water or saline laterally to avoid contaminating the
nasolacrimal duct
• Saturation of the target organ (e.g., potassium iodide [KI] for
iodine isotopes)
• Chelation at the site of entry or in body fluids followed by
rapid excretion (e.g., calcium or zinc diethylenetriamine penta-
acetate [DTPA] for americium, californium, plutonium, and
yttrium)

33. • Acceleration of the metabolic cycle of the radionuclide by
isotope dilution (eg, water for hydrogen-3)
• Precipitation of the radionuclide in the intestinal lumen
followed by fecal excretion (eg, oral calcium or aluminum
phosphate solutions for strontium-90)
• Ion exchange in the GI tract (eg, Prussian blue for cesium-137,
rubidium-82, thallium-201)
 These treatments include the following:
 Potassium iodide.
 Prussian blue Diethylenetriamine penta acetic acid.
 Filgrastim

34. Potassium iodide (Thyroshield, Iosat):
• This is a non radioactive form of iodine.
• It 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

35. 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.

36. Diethylenetriamine penta acetic acid (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

37. 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
exposure to radiation doses > 2 grays (gy)
• Sargramostim (granulocyte macrophage colony-stimulating
factor [GM-CSF]) 5 to 10 mcg/kg sc once/day or 200 to 400
mcg/m2 sc once/day

38. Filgrastim:
• Must follow the labeling instruction before administration
• 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

39. pegfilgrastim (Neulasta):
• Dose of 6mg/0.6ml SC
• Can administer when exposure to radiation > 2gy
• Having ADRs of bone pain and pain in extremity
• Do not administer between 14days before and 24 hours after
administration of cytotoxic chemotherapy.
Sargramostim:
• 250mcg/vial
• IV , lyophilized powder for reconstitution
• ADRs of abdominal pain,diarrhea,asthenia,malaise.

40. Evacuate: If you're advised to evacuate, follow the instructions
provided by your local authorities. Try to stay calm and move
quickly and in an orderly manner. In addition, travel lightly, but
take supplies, including:
• Flashlight
• Portable radio
• Batteries
• First-aid kit
• Necessary medicines
• Sealed food, such as canned foods, and bottled water
• Manual can opener
• Cash and credit cards
• Extra clothes

41. References:
• https://www.slideshare.net/NandhiniSekar3/radiation-
poisoning
• https://www.msdmanuals.com/en-in/professional/injuries-
poisoning/radiation-exposure-and-contamination/radiation-
exposure-and-contamination
• https://www.mayoclinic.org/diseases-conditions/radiation-
sickness/symptoms-causes/syc-20377058
• https://en.wikipedia.org/wiki/Acute_radiation_syndrome
• WWW.PharmaDost.info
• Medscape