Ricin intoxication

 

Substance

蓖麻

 

Common name or Trade name

- contains Ricin 蓖麻毒素

-          Ricinus communis；

-          castor oil plant

-          本草綱目:李時珍曰︰仁甘辛有毒热，氣味颇近巴豆，亦能利人，故下水汽。其性善走，能開通諸竅經絡，故能治偏風、失音口噤、口目斜、頭風七竅諸病，不止于出有形之物而已。蓖麻油能拔病氣出外，故諸膏多用之。 此药外用屢奏奇勋，但内服不可輕率爾。或言捣膏以箸点于鹅馬六畜舌根下，即不能食，或点肛内，即下血死，其毒可知矣[1]。

-          Toxic substance: Ricin [2].

-          ricin-intoxicated patients worldwide described were found in Asia (38% cases), America (30%) and Europe (24%). Intoxication was mostly accidental (74%) [3].  

 

Involving system

-          Route: intravenous home-made castor bean extract, died 6 days after intoxication [4].

-          Route: oral ingestion of the beans. Injection of ricin is believed to be more lethal［5］．

-          Hepatotoxicity [6].

 

Presentation  

 

-          Ricin injection (738 µg of ricin A-chain (∼10.5 µg/kg) 3 ml Injection (IM). resulted in a near-fatal poisoning that evolved with septic shock-like syndrome, multiple organ dysfunction and necrotizing fasciitis [7].

-          Severe abdominal cramps and nausea after injection of a castor bean extract［5］.

-          A fulminant diarrhea developed, resulting in hypovolemic shock and cardiorespiratory collapse.

-          acute gastroenteritis-like disease as primary manifestations leading to severe fluid and electrolyte imbalance.

-          The mechanism of death was peripheral vascular collapse and progressing multiple organ failure (MOF) occurring 10h-72h after intoxication. [3].

 

 

Antidote and Treatment

 

-          No antidote.

-          Symptomatic treatment consisting mostly to rehydration with intravenous fluids and digestive decontamination performed with activated charcoal and/or gastric lavage [3]

This decontamination treatment administered early has been very effective [3] Prompt treatment with supportive care was necessary to limit morbidity and mortality.

-           

Disposition

-          if rapid deterioration of his hemodynamic function: transferred to ICU [5].　

-          Watch out if an outbreak of serious respiratory or gastrointestinal illness [3].

 

References

 

[1]. 中醫寶典. http://zhongyibaodian.com/bcgm/bima.html

 

[2].認識中藥蓖麻籽.香港中藥藥劑師協會https://www.cmpa.org.hk/%E8%AA%8D%E8%AD%98%E4%B8%AD%E8%97%A5%E8%93%96%E9%BA%BB%E5%AD%90/

 

[3]. Abbes M, Montana M, Curti C, Vanelle P. Ricin poisoning: A review on contamination source, diagnosis, treatment, prevention and reporting of ricin poisoning. Toxicon. 2021 May;195:86-92. doi: 10.1016/j.toxicon.2021.03.004. Epub 2021 Mar 9. PMID: 33711365.

 

[4]. Staňková M, Handlos P, Švidrnoch M, Maier V. Fatal intoxication by intravenous injection of castor bean (Ricinus communis L.) extract-a case study. Int J Legal Med. 2020 Nov;134(6):2133-2141. doi: 10.1007/s00414-020-02340-x. Epub 2020 Jun 17. PMID: 32548760.

 

[5]. Verougstraete N, Helsloot D, Deprez C, Heylen O, Casier I, Croes K. Lethal Injection of a Castor Bean Extract: Ricinine Quantification as a Marker for Ricin Exposure Using a Validated LC-MS/MS Method. J Anal Toxicol. 2019 Apr 1;43(3):e1-e5. doi: 10.1093/jat/bky100. PMID: 30590581.

 

[6]. Palatnick W, Tenenbein M. Hepatotoxicity from castor bean ingestion in a child. J Toxicol Clin Toxicol. 2000;38(1):67-9. doi: 10.1081/clt-100100920. PMID: 10696929.

 

[7]. Bucaretchi F, Borrasca-Fernandes CF, Prado CC, Lanaro R, Costa JL, Petroni OM, Giraldi T, Blotta MHSL, Justo-Junior AS, Sousa NL, Aragão FJL, De Capitani EM, Hyslop S. Near-fatal poisoning after ricin injection. Clin Toxicol (Phila). 2021 Feb;59(2):158-168. doi: 10.1080/15563650.2020.1771358. Epub 2020 Jun 1. PMID: 32475181.

edited by Yu-Jang Su   April 13, 2021.