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Potentially life-threatening emergency
Ricin poisoning, ingested - Chem-Bio-Rad Suspicion
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Potentially life-threatening emergency

Ricin poisoning, ingested - Chem-Bio-Rad Suspicion

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Contributors: Alex Garza MD, MPH
Other Resources UpToDate PubMed

Synopsis

Ricin is derived from the castor bean and can be ingested, injected, or aerosolized for inhalation. The CDC has designated ricin as a category B bioterrorism agent. Ricin is less toxic than some other biological agents but is very stable. A similar agent, abrin, derived from rosary peas, is about 25 times more toxic but is less common.

Intoxication occasionally occurs in children and adults who have ingested castor beans or rosary peas or who have chewed castor beans. Person-to-person transmission is not possible.

Extracting the toxin is relatively easy, and Iraq and several terrorist groups are known to have produced ricin. A terrorist attack would be by aerosol release or ingestion.

In 2013, ricin-laced letters were sent by individuals to a handful of public officials at local, state, and national levels.

The mortality rate of ricin is variable and largely route specific; mortality rate would likely be high following a terrorist attack.

Ingestion:

Ricin ingestion is 3 orders of magnitude less toxic compared with other routes. Symptoms begin within 2 hours of ingestion and include abdominal pain, nausea, vomiting, and GI hemorrhaging with bloody vomit and diarrhea. The condition may progress to liver, spleen and kidney failure, hypotension, confusion and drowsiness, seizures, and death.

Ricin intoxication can also occur by inhalation and injection:
  • Inhalation – The initial symptoms of ricin poisoning begin 4-8 hours after inhalation and include fever, nausea, cough, dyspnea, chest pain, and arthralgia. Ricin poisoning may progress to pulmonary edema, ARDS, and cyanosis. A lethal dose would result in death within 36-72 hours.
  • Injection – Myonecrosis and lymphoid necrosis may occur at the injection site. Victims may appear to improve for 1-5 days and then progress to liver, spleen, and kidney failure as well as massive hemorrhaging. Death may result from multiple organ failure.

Codes

ICD10CM:
T62.2X4A – Toxic effect of other ingested (parts of) plant(s), undetermined, initial encounter

SNOMEDCT:
409621007 – Gastrointestinal ricin poisoning

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

The differential includes other bioterrorist agents with severe gastrointestinal symptomatology such as gastrointestinal anthrax. Gastrointestinal anthrax has symptoms within days of exposure; in contrast, ingested ricin poisoning symptoms occur quickly, within a few hours.

Best Tests

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Therapy

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References

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Last Updated: 07/24/2013
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Potentially life-threatening emergency
Ricin poisoning, ingested - Chem-Bio-Rad Suspicion
Print 1 Images
Ricin poisoning, ingested : Abdominal pain, Bloody diarrhea, BP decreased
Copyright © 2019 VisualDx®. All rights reserved.