Clinical features of radiation exposure in children
- Joseph Y Allen, MD
Joseph Y Allen, MD
- Assistant Professor of Pediatrics
- Medical Director, Texas Children's Hospital West Campus Emergency Center
- Baylor College of Medicine
- Erin E Endom, MD
Erin E Endom, MD
- Assistant Professor of Pediatrics
- Baylor College of Medicine
- Section Editor
- Daniel F Danzl, MD
Daniel F Danzl, MD
- Section Editor — Environmental Emergencies
- Professor of Emergency Medicine
- University of Louisville School of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Physicians who treat children who are exposed to radiation must understand the biologic effects of the various types of radiation in order to determine which patients are at risk for radiation injury, to manage patients with radiation exposure, and to minimize the risk of contamination of hospital equipment and personnel.
The types of radiation exposure and the clinical features and presentation of radiation injury in children will be presented here. The management of radiation injury in children and clinical features and management in adults are discussed separately. (See "Management of radiation exposure in children following a nuclear disaster" and "Biology and clinical features of radiation injury in adults" and "Treatment of radiation injury in the adult".)
A basic understanding of radiation physics is necessary for the management of radiation exposure and injury. Radiation is the transfer of energy through space; it occurs in ionizing and nonionizing forms.
Nonionizing radiation — Nonionizing radiation lacks the energy to facilitate the release of electrons from target tissues . Examples of nonionizing radiation include radio waves, microwaves, infrared light, visible light, and ultraviolet rays. Nonionizing radiation does not penetrate human tissue, poses no risk of contamination, and is easily shielded by sunscreens, glasses, clothing, or any other barrier. Nonionizing radiation causes damage to the cells it contacts through direct transfer of thermal energy; sunburn is a classic example .
Ionizing radiation — Ionizing radiation is released by atoms that have an excess of energy, mass, or both (unstable atoms). These atoms emit the excess energy (eg, gamma rays) or mass (eg, alpha particles) to become stable . Ionizing radiation damages human tissue in several ways. It interacts directly with targets such as mRNA, DNA, and proteins, breaks their covalent bonds, and irreversibly destroys their structure . Ionizing radiation also bombards free water to remove an electron and generate H2O+ cations, which quickly decay to highly reactive free radicals that disrupt adjacent cellular architecture and genomic information . Ionizing radiation causes severe cellular disruption that usually results in cell death. However, most cell types do not manifest evidence of damage until mitosis occurs, and several divisions may ensue before actual cell death.
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- RADIATION PHYSICS
- Nonionizing radiation
- Ionizing radiation
- - Particulate
- - Nonparticulate
- Measures of radiation
- LAWS OF RADIOSENSITIVITY
- SOURCES OF RADIATION EXPOSURE
- Background radiation
- Medical exposure
- Industrial exposure
- Nuclear reactors
- Nuclear weapons
- TYPES OF RADIATION EXPOSURE
- - External
- - Internal
- - Partial-body
- - Whole-body
- - Fetal exposure
- ACUTE RADIATION SYNDROME
- Prodromal phase
- Latent phase
- Overt illness phase
- - Hematopoietic
- - Gastrointestinal
- - CNS syndrome