Castor bean poisoning is associated with severe gastroenteritis, multiorgan failure, and cardiovascular shock. The poisoning is attributed to ricin, which is the toxic substance found in castor beans.
Castor beans contain ricin, a toxic compound responsible for the poisoning that ensues with the exposure  . Found in tropical areas , castor beans are used in traditional remedies throughout different parts of the world . They can be purchased on the internet and horticulture and plant shops. When castor beans are ingested, poisoning occurs when ricin is released during mastication . Poisoning has been associated with intake of half a bean to 30 beans .
The clinical course of castor bean poisoning is characterized by the acute and late phases . Fever, which may be the initial symptom, begins within 2 hours of ingestion  . The onset of acute manifestations begins 4 to 6 hours following consumption and consists of oropharyngeal irritation and gastrointestinal symptoms such as emesis, diarrhea, and abdominal pain  . Additionally, patients develop gastrointestinal (GI) bleeding as reflected by hematemesis or hematochezia . Late effects occur 2 to 5 days post ingestion and include toxicity of the liver, kidneys, and adrenal gland . Other features of castor bean poisoning include changes in the mental status .
There are other methods of ricin exposure apart from the consumption of castor beans. Subcutaneous injection of ricin results in symptoms such as a headache, nausea, fatigue, back pain, chest pain, hematochezia, and progression to hypotension and multiorgan failure . In cases with ricin inhalation, the patient experiences dyspnea, cough, and signs of respiratory distress and eventually death .
Severe consequences include cardiovascular shock as a result of volume and electrolyte depletion . Multiorgan failure and death may ensue.
Findings include vital sign changes and evidence of dehydration in those with gastroenteritis. Also, patients may exhibit signs of an allergic reaction such as urticaria, swelling of tongue or face, and bronchospasm. There may be other findings depending on the route of ricin exposure.
When a patient presents with the above manifestations, it is pertinent for the clinician to elicit the medical history, risk factors, and list of food and medication intake and exposures. Additionally, the physical exam and appropriate studies are important in order to attain a full picture. Moreover, it is very helpful to obtain a sample of the consumed beans.
The pertinent studies include a complete blood count (CBC) which is likely to demonstrate anemia and leukocytosis  . Additionally, a comprehensive metabolic panel (CMP) is associated with key findings such as abnormal levels of electrolytes, hypoglycemia, and elevated levels of liver function tests (LFTs), creatinine kinase, creatinine, and bilirubin   . Laboratory results may also reveal metabolic acidosis .
Moreover, a coagulation panel is crucial in hemorrhagic cases. Other tests that should be obtained include a blood type and screening and cultures of the blood, urine, and sputum if needed.
Future tests for detection of ricin and its compounds include a urine assay . Moreover, enzyme-linked immunoassay (ELISA) and polymerase chain reaction (PCR) studies of the urine may be performed at specialized public health facilities. The Centers for Disease Control and Prevention (CDC) may have other methods for ricin detection as well.