March 15, 2011

Please read and try to understand the outline below on nuclear and radiation exposure. It is important to have a basic understanding of this problem. But because this is complicated, be sure to read the section below entitled “BOTTOM LINE”.

Nuclear Warfare
Basic Principles for Health Care Providers
Allan D. Lieberman, M.D.

A. Injuries and consequences from a nuclear accident or exposure comes from

B. Trauma from the explosion and heat should be treated first including any necessary surgery and should be done as soon as possible. The closing of wounds have top priority.

C. Radiation deprives the cells of their potential for mitotic division thus depopulating the essential organ tissues of the body.
1. The time taken from irradiation to tissue reaction is almost dose independent and is governed essentially by the normal turnover rate or longevity of the cells contained in the organ’s tissues.
2. If cells are short lived such as the blood and G.I. tract, the reaction to radiation occurs early. If the cells are long lived the reaction to radiation is late (nervous system).
3. The severity of damage increases with the dose so the depopulation of normal mature cells lasts longer the higher the dose but proceeds at a constant rate. The lower the dose the earlier the onset of repopulation.

D. There are 3 basic types of ionizing radiation:
Alpha- very weak penetrance, a sheet of paper will stop them
Beta- fast moving electrons midway between alpha and gamma
Gamma- high energy and frequency rays which cannot be easily stopped or absorbed (Protect with cotton overalls, lead apron, and scuba to prevent inhalation)

E. Radiation exposure is measured in RADS (radiation absorbed dose)

F. Ionizing radiation causes the formation of free radicals and chemical changes which include changes in amount of MEDIATORS which serve as intercellular communications:
1. Irradiation INCREASES the levels of a multitude of GROWTH FACTORS including erythropoietin.
Hematopoietic colony stimulating factors IL1, 2, 6, TNF, TGFalpha and beta basic fibroblast growth factor (bFGF) platelet derived growth factor (PDGF), endothelin-1
2. Eicosanoids: Prostaglandins, prostacyclin, thromboxanes, and leukotrienes. Irradiation stimulates the over production of these eicosanoids resulting in dysregulationof the vasculature and/or endothelial damage. The damage is not the direct action of the radiation but mediated through the eicosanoids. This is documented by the use of drugs which inhibit eicosanoids such as corticosteroids and NSAIDS.

Therefore: Tissue reactions to radiation involve:
1. Interference with the continuous replacement of mature cells lost from their self-renewing populations through normal wear and tear but also
2. Profound changes in cellular communication by means of extracellular mediators
3. Various toxicities from protein grown factors which causes fever, chills, nausea, vomiting, diarrhea, edema, headache, decreased blood pressure, and renal failure.

ACUTE RADIATION SYNDROME(Occurs when radiation exceeds 100 RADS)

G. Triaging Radiation Injured
It is impossible to predict which patients will have radiation sickness later.

PRODROME– initial toxic period 1-6 hours post exposure
LATENT– period of well being days to weeks depending on dose
MANIFEST ILLNESS– resulting from injuries sustained by susceptible organs RECOVERY
LONGTERM EFFECT OF RADIATON– Cancer, shortening of lifespan sterility and cataracts.

Monitor lymphocyte initially and at 48 hours post radiation as response to the exposure.
1500 or more MILD
1000-1500 MODERATE
500-1000 SEVERE
0-100 LETHAL
Lymphocyte counts- early sign
Granulocyte and platelet counts- later sign

Chromosome studies are very valuable. As little as 11 RADS can alter them. Lack of vomiting in first few hours indicates that severe injury is unlikely. Thus the presence or absence of nausea and vomiting differentiates between fatal and non fatal exposure.
Vomiting within 3 hours denotes higher exposure.
Explosive diarrhea denotes lethal exposure.

H. Treatment of radiation injury
1. Treat all manifestations of trauma and burns first including necessary surgery
2. In patients with multiple injuries who survive 5 days, infection is second after head injury as cause of death. Organisms come from both exogenous and endogenous sources and can cause major organ system dysfunction or failures. Gram negative bacteria are the most common cause. It is important to maintain colonization resistance (CR) = regulation of populations of opportunistic pathogens after trauma. Therefore:
3. Use selective antibiotics- usually 2 or more and add Nystatin
4. Combine glucocorticoids with antibiotics.
5. Prostaglandin inhibition- steroids, NSAIDS, and H1, H2 Blockers
6. IV antioxidants- Viatmin C, L-Glutathione
7. Bone marrow transplants if indicated- Takes 2 weeks to correct pancytopenia so give it no later than first week after radiation


Mobley, J.A. Nuclear Accidents, American Family Physician. 1982, 25 (2): 163-172.

Conklin et. Al. Current Concepts in Management of Radiation Injuries and Associated Trauma. Surg. Gyn. Obstetrics. 1983,156: 809-828.

Bottom Line:
A. Stay indoors and protected with clothes covering most of body.
B. Prepare a first response kit and have it ready.
1. Tablets of Ioderal- 2 tabs within 4 hours of known radiation exposure- Take daily
2. Have a bottle of Ibuprofen- Take 1 long acting capsule twice a day; Pepcid 1 two times per day
3. Melatonin 3mg tablets to protect your DNA- Take one tab every 8 hours
4. Vitamin C crystals- Take 1 tsp four times per day in water
5. L-glutathione crystals- Take 1 tsp four times per day in water
6. Chelate your body burden of heavy metals- You can use Chlorella 5 beads three times per day and Modified Citrus Pectin 2 capsules two times per day.

The Center has a limited supply of some of these materials.
Ioderal- 1 bottle of 90 tablets is $25.00
Melatonin 3mg- 1 bottle of 60 tablets is $8.00
Vitamin C- 1 bottle of 150 grams is $22.50
L-Glutathione- 1 bottle of 50 grams is $60.00
Modified Citrus Pectin Chelation Complex- 1 bottle of 60 capsules is $41.00

Buy Ibuprofen (Aleve, Advil, or other brand including store brand), Pepcid, Benedryl 25mg caps at any drug store.

To Your Health,
Allan Lieberman, M.D., F.A.A.E.M.
Medical Director,
The Center for Occupational and Environmental Medicine

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