About Time to Onset of Vomiting

Warning: cautions and limitations

  • Vomiting is not specific for radiation exposure, especially in infants and children.
  • It occurs with many clinical disorders as well with mass casualty events involving
    • Physical trauma
    • Psychological stress
    • Biological threats
    • Chemical threats
  • The vomiting algorithm in this tool was provided by AFRRI and is based on the AFRRI BAT program.
  • Used alone, time to onset of vomiting provides an imperfect estimation of radiation absorbed dose, but initially may be the only clinical information available.
  • Thus, time to onset of vomiting following exposure should be used with caution, and in conjunction with clinical signs and symptoms and other biodosimetry information.
    (See radiation exposure algorithm)
  • See detailed clinical caveats in:

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Background information 2-7

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Radiation Dose vs. Time to Onset of Vomiting

Time to onset of vomiting and dose
Notes on the graph above:
  • Graph uses a log scale on both the x- and y-axes.
  • Each plotted point represents a unique patient.
  • Doses were estimated at "midline" of the body for each patient.
  • Dose rates used to create this graph range from very high doses in accident cases to 0.3 Gy/min in radiotherapy patients.
  • The red line represents the best fit line for the composite data.
  • The dotted blue lines represent the 95% confidence limits around this value.
Sources of data for the graph above:
  • AFRRI BAT software application
  • Anno GH, Baum SJ, Withers HR, Young RW. Symptomatology of acute radiation effects in humans after exposure to doses of 0.5-30 Gy. Health Phys. 1989 Jun;56(6):821-38. [PubMed Citation]
  • Goans RE, Clinical care of the radiation-accident patient: patient presentation, assessment, and initial diagnosis. In: Ricks RC, Berger ME, Ohara FM, Jr. (eds) The Medical Basis for Radiation-Accident Preparedness, The Clinical Care of Victims, Proceedings of the 4th International Conference REAC/TS Conference on The Medical Basis of Radiation Accident Preparedness, Orlando, FL, March 2001. Boca Raton, FL: The Parthenon Publishing Group.

Time to onset of vomiting and dose over a range of 2-10 Gy
Notes on the graph above:
  • Left y-axis reflects time (in hours) to onset of vomiting after a radiation event.
  • Right y-axis reflects percent of patients expected to vomit at a particular radiation dose.
  • X-axis reflects estimated whole body dose received (measured in gray).
Source of data for the graph above:

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  1. Camarata AS, Switchenko JM, Demidenko E, Flood AB, Swartz HM, Ali AN. Emesis as a Screening Diagnostic for Low Dose Rate (LDR) Total Body Radiation Exposure. Health Phys. 2016 Apr;110(4):391-4. [PubMed Citation]
  2. Demidenko E, Williams BB, Swartz HM. Radiation dose prediction using data on time to emesis in the case of nuclear terrorism. Radiat Res 2009 Mar; 171(3):310-9. [PubMed Citation]
  3. Parker DD, Parker JC. Estimating radiation dose from time to emesis and lymphocyte depletion. Health Phys. 2007 Dec;93(6):701-4. [PubMed Citation]
  4. Waselenko JK, MacVittie TJ, Blakely WF, Pesik N, Wiley AL, Dickerson WE, Tsu H, Confer DL, Coleman CN, Seed T, Lowry P, Armitage JO, Dainiak N; Strategic National Stockpile Radiation Working Group. Medical management of the acute radiation syndrome: recommendations of the Strategic National Stockpile Radiation Working Group. Annals of Internal Medicine 2004; Vol. 140:1037-51. [PubMed Citation]
  5. NATO Handbook on the Medical Aspects of NBC Defensive Operations AMedP-6(B), Chapter 6, General Medical Effects of Nuclear Weapons: Diagnosis, Treatment, and Prognosis, 1 February, 1996.
  6. Time/Dose Effects in Acute Radiation Syndrome - Acute Clinical Effects of Single-Dose Exposure of Whole-Body Irradiation
  7. Time Phases of the Acute Radiation Syndrome (ARS)
  8. Armed Forces Radiobiology Research Institute (AFRRI) - Biodosimetry Assessment Tool (BAT)
  9. Diagnosis and Treatment of Radiation Injuries (PDF - 202 KB) (IAEA Safety Reports Series No. 2, Vienna 1998)

See also: