Edit concept Create issue ticket

Castor Bean Poisoning

Ricin Poison

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.


Presentation

Castor beans contain ricin, a toxic compound responsible for the poisoning that ensues with the exposure [1] [2]. Found in tropical areas [3], castor beans are used in traditional remedies throughout different parts of the world [2]. 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 [4]. Poisoning has been associated with intake of half a bean to 30 beans [4].

The clinical course of castor bean poisoning is characterized by the acute and late phases [2]. Fever, which may be the initial symptom, begins within 2 hours of ingestion [5] [6]. 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 [1] [7]. Additionally, patients develop gastrointestinal (GI) bleeding as reflected by hematemesis or hematochezia [7]. Late effects occur 2 to 5 days post ingestion and include toxicity of the liver, kidneys, and adrenal gland [2]. Other features of castor bean poisoning include changes in the mental status [8].

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 [1]. In cases with ricin inhalation, the patient experiences dyspnea, cough, and signs of respiratory distress and eventually death [1].

Complications

Severe consequences include cardiovascular shock as a result of volume and electrolyte depletion [4]. Multiorgan failure and death may ensue.

Physical exam

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.

Cough
  • In cases with ricin inhalation, the patient experiences dyspnea, cough, and signs of respiratory distress and eventually death. Complications Severe consequences include cardiovascular shock as a result of volume and electrolyte depletion.[symptoma.com]
  • Inhaled ricin causes fever, chest tightness, cough and severe respiratory problems, including fluid buildup in the lungs (pulmonary edema). Ingested ricin causes intestinal bleeding and organ damage.[mayoclinic.org]
  • Symptoms of ricin poisoning depend upon the amount of the toxin, and the method of exposure, but may include: Fever Vomiting Nausea Severe cough Abdominal pain Diarrhea Dehydration Flu-like symptoms Signs and symptoms usually begin within 4-6 hours of[emedicinehealth.com]
  • Inhalation: Within a few hours of inhaling significant amounts of ricin, the likely symptoms would be respiratory distress (difficulty breathing), fever , cough , nausea , and tightness in the chest.[medicinenet.com]
  • Instead of gastrointestinal problems, you'll develop a vicious, bloody cough, your lungs will fill with fluid, and eventually you'll lose your ability to breathe, causing death.[popsci.com]
Anemia
  • Laboratory tests The pertinent studies include a complete blood count (CBC) which is likely to demonstrate anemia and leukocytosis.[symptoma.com]
  • Supportive care* For severe anemia and poisoning, gradual removal and replacement of blood with equal volumes of fresh donor blood (exchange transfusion) considered Green potatoes and potato sprouts Gastroenteritis, hallucinations, and delirium Supportive[merckmanuals.com]
Disability
  • The report actually says that for such a weapons system to be effective it must disable immediately and kill within fifteen minutes.[thepoisongarden.co.uk]
Vomiting
  • Pictured: Castor Bean Poisonous to: Cats, Dogs Level of toxicity: Generally moderate to severe, life-threatening Common signs to watch for: Inappetanc Drooling Abdominal pain Vomiting Severe bloody diarrhea Abdominal straining Weakness Trembling Hypotension[petpoisonhelpline.com]
  • If the dose was sufficient and the disease has progressed, vomiting blood or passing bloody diarrhea or dark-colored tarry stools may occur.[emedicinehealth.com]
  • It's a highly unpleasant way to be poisoned: within six hours, according to the Center for Disease Control, victims who have ingested ricin will feel gastrointestinal effects like severe vomiting and diarrhea, which can lead to serious dehydration.[popsci.com]
  • Ingestion: If someone swallows a significant amount of ricin, he or she would likely develop vomiting and diarrhea that may become bloody. Severe dehydration may be the result, followed by low blood pressure .[medicinenet.com]
  • Dehydration and vomiting are more dangerous for children than adults, so ingestion of a single castor bean seed may be fatal for a child.[thoughtco.com]
Diarrhea
  • Pictured: Castor Bean Poisonous to: Cats, Dogs Level of toxicity: Generally moderate to severe, life-threatening Common signs to watch for: Inappetanc Drooling Abdominal pain Vomiting Severe bloody diarrhea Abdominal straining Weakness Trembling Hypotension[petpoisonhelpline.com]
  • 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.[symptoma.com]
  • If the dose was sufficient and the disease has progressed, vomiting blood or passing bloody diarrhea or dark-colored tarry stools may occur.[emedicinehealth.com]
  • What are the symptoms: Victims who ingest the protein get severe nausea and diarrhea. If it is inhaled, the patient will also have difficulty breathing and fluid will build up in the lungs.[businessinsider.com]
  • As syndrome progresses, bloody diarrhea may occur, and convulsions and coma can precede death.[aspca.org]
Nausea
  • 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.[symptoma.com]
  • Symptoms of ricin poisoning depend upon the amount of the toxin, and the method of exposure, but may include: Fever Vomiting Nausea Severe cough Abdominal pain Diarrhea Dehydration Flu-like symptoms Signs and symptoms usually begin within 4-6 hours of[emedicinehealth.com]
  • What are the symptoms: Victims who ingest the protein get severe nausea and diarrhea. If it is inhaled, the patient will also have difficulty breathing and fluid will build up in the lungs.[businessinsider.com]
  • Symptoms of castor bean poisoning include nausea, abdominal cramps, vomiting, internal bleeding , and kidney and circulation failure.[adventure.howstuffworks.com]
  • This outer coating can cause nausea; vomiting; diarrhea; abdominal pain; dehydration; shock; blood cell destruction; severe fluid and chemical disturbances; liver, kidney, and pancreas damage; and death.[m.webmd.com]
Abdominal Pain
  • Pictured: Castor Bean Poisonous to: Cats, Dogs Level of toxicity: Generally moderate to severe, life-threatening Common signs to watch for: Inappetanc Drooling Abdominal pain Vomiting Severe bloody diarrhea Abdominal straining Weakness Trembling Hypotension[petpoisonhelpline.com]
  • 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.[symptoma.com]
  • People who ingested it may have abdominal pain , often accompanied by vomiting and diarrhea . Because of this, they may also become dehydrated.[emedicinehealth.com]
  • Poisoning Symptoms: Increase in body temperature accompanied by depression, this will progress to vomiting, profuse diarrhea with or without blood, extreme abdominal pain followed by convulsions, collapse and death occurring within 36 hours of consumption[pawsdogdaycare.com]
  • When ingested, especially if chewed, castor beans can cause gastrointestinal symptoms: abdominal pain, nausea, vomiting, diarrhea and volume depletion.[thepoisonreview.com]
Abdominal Cramps
  • Symptoms of castor bean poisoning include nausea, abdominal cramps, vomiting, internal bleeding , and kidney and circulation failure.[adventure.howstuffworks.com]
  • . † Cholinergic symptoms include a slow heart rate, weakened contraction of the heart, dangerously low blood pressure, difficulty breathing (because airways are constricted), flushing, abdominal cramps, diarrhea, increased urination and salivation, watery[merckmanuals.com]
  • Castor oil is good for skin ailments, be it burns or abrasions, styes in the eyes (though officially it should be kept out of the eyes), and as a rub or ointment it can help with everything from headaches, sinus infection and abdominal cramping.[gothichorrorstories.com]
Jaundice
  • Supportive care* Nightshade, deadly Anticholinergic ‡ symptoms, a high body temperature, seizures, and hallucinations Supportive care* For a very high body temperature or seizures, possibly physostigmine Pennyroyal Damage to the liver (when severe, causing jaundice[merckmanuals.com]
Seizure
  • This could include ventilation to help breathing, giving fluids to help stave off dehydration, and giving medication to stop seizures and raise blood pressure.[businessinsider.com]
  • Symptoms include delayed gastroenteritis, which may be severe and hemorrhagic, followed by delirium, seizures, coma, and death.[thehealthscience.com]
  • Other signs or symptoms may include seizures , and blood in the urine . Within several days, the person's liver , spleen, and kidneys might stop working, and the person could die.[medicinenet.com]
  • People develop a dry mouth and later a rapid heartbeat, tremors, sweating, seizures, and muscle weakness. Water hemlock may cause vomiting and diarrhea, delirium, seizures, and coma.[merckmanuals.com]
  • Depending on how a victim was exposed, they could receive breathing assistance, intravenous fluids to combat dehydration, or anti-seizure or blood pressure medication.[thedailybeast.com]

Workup

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.

Laboratory tests

The pertinent studies include a complete blood count (CBC) which is likely to demonstrate anemia and leukocytosis [4] [9]. 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 [4] [9] [10]. Laboratory results may also reveal metabolic acidosis [1].

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.

Diagnostic tools

Future tests for detection of ricin and its compounds include a urine assay [11]. 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.

Treatment

  • But a cocktail of antibodies could one day offer victims at least a slim window for treatment.[sciencenews.org]
  • How is it treated: Treatment basically tries to minimize the effects of the symptoms of the poison.[businessinsider.com]
  • Is There a Treatment or Cure for Ricin Poisoning? There is no available antidote or vaccine. Regardless of the route of exposure, treatment remains mainly supportive. In the case of an inhalation, the person may need assistance with breathing.[emedicinehealth.com]
  • If exposure cannot be avoided, the first step in treatment is to get it off or out of the body as quickly as possible. Treatment for poisoning involves supportive medical care to minimize the effects of the poison.[medicinenet.com]
  • Treatment is primarily supportive care.[mayoclinic.org]

Epidemiology

  • Epidemiology Frequency United StatesJequirity and castor bean ingestions are extremely uncommon.[thehealthscience.com]
  • The symptoms in these monkeys correlate well with other epidemiological and animal data to suggest that this was the cause of ALS-PD there.[networks.h-net.org]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology These beans contain potent toxalbumins that inhibit protein synthesis and cause severe cytotoxic effects on multiple organ systems. Castor beans contain the toxalbumin ricin, and jequirity beans contain abrin.[thehealthscience.com]

Prevention

  • Centers for Disease Control and Prevention. . Accessed Feb. 5, 2016. Steckelberg JM (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 9, 2016. See more Expert Answers .[mayoclinic.org]
  • The subject is discussed from the point of view of prevention. Keywords Castor Bean Accidental Poisoning Opium Poisoning Intravenous Fluid Therapy Santonin These keywords were added by machine and not by the authors.[link.springer.com]
  • The Centers for Disease Control and Prevention (CDC) may have other methods for ricin detection as well.[symptoma.com]
  • If ingested, ricin gets inside the body’s cells and prevents them from making proteins they need, killing those cells.[medicinenet.com]

References

Article

  1. Moshiri M, Hamid F, Etemad L. Ricin Toxicity: Clinical and Molecular Aspects. Rep Biochem Mol Biol. 2016;4(2):60-65.
  2. AL-Tamimi FA, Hegazi AEM. A Case of Castor Bean Poisoning. Sultan Qaboos Univ Med J. 2008;8(1):83-87.
  3. Ferraz AC, Angelucci ME, Da Costa ML, et al. Pharmacological evaluation of ricinine, a central nervous system stimulant isolated from Ricinus communis. Pharmacol Biochem Behav. 1999;63(3):367–75.
  4. Challoner KR, McCarron MM. Castor bean intoxication: review of reported cases. Ann Emerg Med. 1990;19(10):1177–1183.
  5. Pillay VV, Bhagyanathan PV, Krishnaprasad R, Rajesh RR, Vishnupriya N. Poisoning due to white seed variety of Abrus precatorius. J Assoc Physicians India. 2005;53:317–319.
  6. Kulkarni ML, Sreekar H, Keshavmurthy KS, Shenoy N. Jatropha curcas - poisoning. Indian J Pediatr. 2005;72(1):75–76.
  7. Coopman V, De Leeuw M, Cordonnier J, et al. Suicidal death after injection of a castor bean extract (Ricinus communis L.). Forensic Sci Int. 2009;189(1-3):e13–20.
  8. Lampe KF, Fagerstorm R. Plant toxicity and dermatitis. Baltimore, MD: Lippincott Williams & Wilkins; 1968.
  9. Wedin GP, Neal JS, Everson GW, Krenzelok EP. Castor bean poisoning. Am J Emerg Med. 1986;4(3):259–261.
  10. Balali-Mood M, Moshiri M. Problems of Clinical Diagnosis and Management of a Deliberate Biological Born Disease. J Bioterror Biodef. 2015;6:e113.
  11. Johnson RC, Lemire SW, Woolfitt AR. et al. Quantification of ricinine in rat and human urine: a biomarker for ricin exposure. J Anal Toxicol. 2005;29(3):149-155.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2018-06-22 01:16