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manifestations of ARS may range from minimal intervention to the use of parenteral
fluids and antiemetic agents. Antiemetic agents include ondansetron or granisetron at
dosages commonly used to prevent nausea and vomiting during chemotherapy. For
children 4–18 years of age, ondansetron is usually given at 0.15 mg/kg tid, and
granisetron at 10 µg/kg/day. However, antiemetics may be contraindicated initially,
particularly if catharsis is deemed necessary for internal decontamination.
During the first day, the focus should be not only on treating acute symptoms, but also on
systematically recording them as a way of estimating the dose involved. When combined
with other biodosimetric indices, the time to onset of clinical symptoms is particularly
useful in determining prognosis and the extent of supportive care that may be needed
much later in the clinical course.
Nutrition. Maintenance of adequate nutrition is important to counter the catabolic effects
of radiation and to 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. Parenteral feeding may be necessary if the patient is not able to tolerate oral
feedings or if fluid loss is profound due to diarrhea.
Hematopoietic syndrome. The main focus of supportive therapy in patients with
survivable exposures between 1 and 8 Gy centers around the hematopoietic system.
Hematopoietic syndrome may not become clinically apparent until after a latent period of
2–4 weeks. A key feature of this syndrome is neutropenia.
Established or suspected infection after exposure to radiation is usually characterized by
neutropenia and fever. In general, such patients can be managed the same as other febrile
neutropenic patients. However, important differences between the two conditions exist.
Most individuals exposed to irradiation are otherwise healthy. They also generally are
exposed to total body irradiation without the shielding that is used in therapeutic
exposure to irradiation. Patients with neutropenia after radiation are also susceptible to
irradiation damage to other tissues (e.g., lungs, CNS, etc.), which may require therapeutic
interventions not needed in other types of neutropenic patients. Furthermore, irradiated
individuals may respond to antimicrobial therapy in unpredictable ways, as has been
shown in experimental studies in which metronidazole and pefloxacin therapies were
detrimental to irradiated laboratory animals.
Neutropenia: Cytokine Therapy
Hematopoietic growth factors, such as granulocyte colony stimulating factor (G-CSF)
and granulocyte macrophage colony stimulating factor (GM-CSF), are not FDA approved
for the management of radiation-induced marrow aplasia. However, these growth factors
have been used in the aftermath of a number of radiation accidents (e.g., Chernobyl and
Goiania) in an effort to lessen the severity and duration of neutropenia and thereby reduce
the risk of infection. The experience with these few clinical cases, along with even more
convincing data from controlled studies in animals, suggest that early cytokine therapy
can significantly enhance survival. Benefit is maximal if treatment begins within the first
24–72 hours after radiation exposure. In the absence of significant complicating injuries,
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