Regardless of the type of radiation involved, supportive therapy will be of central importance to minimizing the morbidity and mortality of patients with significant whole body exposure. Before or shortly after this therapy is initiated, a baseline history regarding the source of radiation, the duration of exposure, the interval between exposure and presentation, and the physical property of the radioactive compounds (e.g., solid, liquid, particulate) should be obtained. ( Reeves GI. Medical implications of enhanced radiation weapons. Mil Med. 2010 ;175: 964 ) The review of systems and physical examination should be as complete as possible but particularly focused on the earlier reacting organ systems such as the skin, hematopoietic, gastrointestinal, and neurovascular systems.
Once the patient has been medically stabilized and decontaminated, and appropriate samples have been obtained for biological dosimetry, attention can be aimed at addressing the first symptoms likely to occur during the prodromal phase such as nausea, vomiting, and diarrhea. Treatment of these early manifestations of ARS may range from minimal intervention to the use of parenteral fluids and anti-emetic agents such as ondansetron (Zofran) or granisetron (Kytril) at dosages commonly used during radiotherapy (for pediatric patients, 0.15 mg per kg per dose every 4 hours and 10mcg/kg/dose once a day to twice a day, respectively) (Anonymous, Physicians’ Desk Reference, 2011 ). Anti-emetics may be contraindicated initially, however, particularly if catharsis is deemed necessary for internal decontamination. During the first day, it is important to remember that the focus should not only be on treating these acute symptoms, but also systematically recording them in an attempt to estimate the dose involved. Particularly when combined with biodosimetry, the time to onset of these clinical symptoms will be useful in determining prognosis as well as the extent of the supportive care that may be needed much later in the clinical course. (Bland SA. Mass casualty management for radiological and nuclear incidents. J R Army Med Corps. 2004;150 (3 Suppl 1):27).
Nutrition: Maintenance of adequate nutrition is important to counter the catabolic effects of radiation and allow healing and recovery. Oral feeding is preferred if possible to maintain functioning of the intestinal mucosa and reduce risk of infection from parenteral feeding. If the patient is not able to tolerate oral feedings or if fluid loss is profound due to diarrhea, parenteral feeding may be necessary.
Hematopoietic Syndrome: The main focus of supportive therapy in patients with survivable exposures between 1 and 8 Gray will eventually center around the hematopoietic syndrome. These hematologic manifestations may not become clinically apparent until after a 2 to 4 week latent period.
