How does radiation poisoning kill you, and why does it sometimes take weeks?
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Radiation damages the molecules in your body. The most sensitive molecule in terms of both being fragile enough to easily damage and being important when it is is your DNA.
When damage is done to your DNA, it can usually be repaired if the damage isn’t too bad. It’s happening all the time, both due to background radiation and due to chemical reactions, and your body has mechanisms to double-check that it is correct and to kill cells that are malfunctioning. In severe radiation sickness, however, the damage is too bad for this process to work: the DNA is damaged so badly that it can’t function normally.
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In the slower deaths from radiation sickness, the DNA is damaged badly enough that cells can’t properly divide, but not so badly that all of your cells stop working at all. The initial damage, and all the cells that *do* malfunction, triggers a massive immune response that makes you sick for a little bit, but then you recover a little. Most of your cells are still working, so your body can recover some normal function. The problem is that you’re on the clock: as your cells die, your body can no longer replace them.
The shortest-lived cells are the cells of your skin and intestinal lining and your blood cells, so those areas get hit first. Since you fail to produce new red blood cells, you start to become severely anemic as your old red blood cells die. White blood cells are longer-lived, but to respond to infection they need to multiply, which they can no longer do. And this is doubly bad because the failure of your intestinal lining and skin opens you up to bleeding and infection. Your disrupted intestines stop you from absorbing nutrients and give nasty gastrointestinal symptoms like diarrhea and vomiting.
You typically die of a mix of failures: internal hemorrhaging from the breakdown of cell linings, anemia from the lack of red cells, infection from the lack of white cells, dehydration and malnutrition from your failed intestines. This is a slow and very painful death over weeks to months as your body slowly decays.
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In more severe cases, the damage is so extreme that it disrupts function immediately and causes an immune response way beyond what your body can safely do. You go right to vomiting, diarrhea, mental confusion, and coma, and you die quickly as the severe disruption to your entire body disrupts its ability to support vital organs like the brain.
This death is quicker. In the most severe cases, you lose consciousness quickly and die within a day or two. In others, you’ll be in a bit of a fever state while your body fails over the course of a few days to a week.
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