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Ricin Poisoning by Inhalation

Inhalational Ricin Poisoning


Presentation

  • A new study presented February 7 at the American Society for Microbiology’s Biothreats meeting reveals a ricin antidote that, in mice, works even days after exposure to the toxin.[sciencenews.org]
  • The rapid tests indicate whether components of the castor bean are present in the environmental sample and whether ricin toxin is present. If both yield a "positive" result, then the presence of ricin can be confirmed.[news.nationalgeographic.com]
  • Fluid loss may present as tachycardia or shock. Liver and renal dysfunction and death can occur.[patient.info]
  • "Since many of the toxicologists in my branch at the CDC were also practicing emergency medicine physicians we decided to focus on the clinical presentation and management of ricin toxicity, based on route of exposure," she said.[app1.unmc.edu]
Military Personnel
  • Mass casualties could result from food adulteration but also from inhalation of aerosolized toxin; SEB was developed for use as an aerosol to cause incapacitation in military personnel.[merckmanuals.com]
  • Vaccines to prevent poisoning in individuals such as military personnel are also under development.[britannica.com]
  • A vaccine has recently been successfully tested in animals and human volunteers 6 and might be given to military personnel where biological warfare agents are a potential threat.[forensicmag.com]
Anemia
  • Nevajda, and Rajko Kusec pp. 318–320 Abstract Full text PDF Abstract letters Skull metastasis from hepatocellular carcınoma with hepatitis C Fatih Ermis, Memduh Dursun, Ramazan Kurt, and Filiz Akyuz pp. 321–322 Full text PDF Fever of unknown origin, anemia[annsaudimed.net]
Cough
  • In survivors, fever may persist up to 5 days and cough for 4 wk. Specialized toxin assays may help confirm the diagnosis. Treatment is supportive.[merckmanuals.com]
  • All exposures typically develop fever, coughing and gastrointestinal complications.[globalsecurity.org]
  • Inhaling ricin causes coughing, pulmonary oedema and death. If ingested, it causes gastroenteritis, liver and kidney damage and death from circulatory failure. There is no antidote. Data acquisizione: 12 giugno 2013[alamy.it]
  • Fever, chest tightness, cough, nausea, and joint pain may occur. Ricin can cause cell death in the respiratory system and eventual respiratory failure.[science.jrank.org]
  • A person would experience trouble breathing, fever, cough and nausea, a build up of fluid in the lungs, and eventually respiratory failure.[articles.latimes.com]
Tachypnea
  • Parenteral exposure results in fever, tachycardia, tachypnea, hypotension, hepatitis, pancreatitis, nephritis, myocardial injury, cerebral edema, vomiting, diarrhea, and bone marrow suppression.[centerforhealthsecurity.org]
Nasal Irritation
  • Inhalation causes nonproductive cough, retrosternal chest pain, and often nasal irritation and congestion. Conjunctivitis can result from contact of aerosol with the eyes.[merckmanuals.com]
Vomiting
  • Symptoms of injection with ricin include: Pain and swelling at the injection site Flulike symptoms Nausea Vomiting Body aches. As time passes, symptoms become more severe, and a life-threatening syndrome can develop.[webmd.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]
  • Gastric ingestion of ricin causes nausea, vomiting, diarrhea, abdominal cramps and dehydration.[ehs.unc.edu]
  • As with wound botulism, neurologic symptoms (typically bilaterally symmetrical descending paralysis with mydriasis) without nausea, vomiting, cramping, or diarrhea would be expected 12 to 36 h (range 2 h to 8 days) after exposure.[merckmanuals.com]
  • It may cause abdominal pain, nausea, vomiting, and bloody diarrhea. Eventual complications include cell death in the liver, kidney, adrenal glands, and central nervous system.[science.jrank.org]
Nausea
  • Fever, chest tightness, cough, nausea, and joint pain may occur. Ricin can cause cell death in the respiratory system and eventual respiratory failure.[science.jrank.org]
  • All reported serious or fatal cases of castor bean ingestion have taken approximately the same course: rapid onset of nausea, vomiting, abdominal cramps, and severe diarrhea with vascular collapse.[globalsecurity.org]
  • As with wound botulism, neurologic symptoms (typically bilaterally symmetrical descending paralysis with mydriasis) without nausea, vomiting, cramping, or diarrhea would be expected 12 to 36 h (range 2 h to 8 days) after exposure.[merckmanuals.com]
  • Nausea, cough and breathing difficulties occur as well. In severe cases of poisoning death soon occurs usually as a result of respiratory or circulatory failure.[ic.steadyhealth.com]
Diarrhea
  • As with wound botulism, neurologic symptoms (typically bilaterally symmetrical descending paralysis with mydriasis) without nausea, vomiting, cramping, or diarrhea would be expected 12 to 36 h (range 2 h to 8 days) after exposure.[merckmanuals.com]
  • It may cause abdominal pain, nausea, vomiting, and bloody diarrhea. Eventual complications include cell death in the liver, kidney, adrenal glands, and central nervous system.[science.jrank.org]
  • All reported serious or fatal cases of castor bean ingestion have taken approximately the same course: rapid onset of nausea, vomiting, abdominal cramps, and severe diarrhea with vascular collapse.[globalsecurity.org]
  • A possible clue to an attack involving ricin inhalation would be that a number of people who had been close to each other suddenly developed fever, diarrhea, cough, and excess fluid in their lungs.[www1.nyc.gov]
  • . • Ingestion : If someone swallows a significant amount of Ricin, he or she would develop vomiting and diarrhea that may become bloody.[people.uwec.edu]
Abdominal Pain
  • It may cause abdominal pain, nausea, vomiting, and bloody diarrhea. Eventual complications include cell death in the liver, kidney, adrenal glands, and central nervous system.[science.jrank.org]
  • Ricin-related symptoms include fever and nausea, which progresses to severe abdominal pains and fits. Victims die from multiple organ failure and there is no known antidote or vaccine.[theguardian.com]
  • Other symptoms to watch out for are: * Bloody diarrhoea, vomiting and abdominal pain. * Pulmonary oedema, pneumonia and ARDS. * Seizures and Central Nervous System depression. * Fluid loss may cause tachycardia. * Allergic responses have been reported[irishhealth.com]
Abdominal Cramps
  • All reported serious or fatal cases of castor bean ingestion have taken approximately the same course: rapid onset of nausea, vomiting, abdominal cramps, and severe diarrhea with vascular collapse.[globalsecurity.org]
  • Gastric ingestion of ricin causes nausea, vomiting, diarrhea, abdominal cramps and dehydration.[ehs.unc.edu]
Cyanosis
  • 70 micrograms ( a grain of salt ) Inhalation toxicity of ricin Aerosol poisoning LD50 is 3 mcg / kg Ricin inhalation symptoms Within 8 hours Acute nasal and throat congestion Pulmonary edema Cyanosis Hypotension Ricin inhalation symptoms Within 36-72[quizlet.com]
  • Patients may experience heavy sweating and pulmonary edema resulting in cyanosis. Low blood pressure and respiratory failure may occur, leading to death.[centerforhealthsecurity.org]
  • In severe cases, these symptoms develop: convulsions; cyanosis; collapse (a sharp drop in blood pressure); prostration.[en.intoxication-stop.com]
Seizure
  • Dehydration, hallucination, seizures and blood in the urine may result. Death typically occurs on the third day or later after possible liver, spleen or kidney failure.[globalsecurity.org]
  • 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]
  • 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]
  • Other signs or symptoms may include hallucinations, seizures, and blood in the urine. Within several days, the person's liver, spleen, and kidneys might stop working, and the person could die.[health.ny.gov]
  • . • Other signs or symptoms may include hallucinations, seizures, and blood in the urine.[people.uwec.edu]

Workup

Staphylococcus Aureus
  • Staphylococcal enterotoxin B (SEB) is one of 7 enterotoxins (toxins acting in the intestine) produced by Staphylococcus aureus. SEB is responsible for staphylococcal food poisoning when ingested.[merckmanuals.com]

Treatment

  • What treatment is to be provided? Treatment is symptomatic and supportive. No antidote is available for the treatment of ricin poisoning. Patients with symptoms should be admitted.[irishhealth.com]
  • There are no guidelines regarding the treatment of ricin poisoning during pregnancy. Owing to the severity of complications associated with ricin exposure, treatment of the pregnant patient should be the same as for the non-pregnant patient.[medicinesinpregnancy.org]
  • Severe bleeding leads to shock, a life-threatening complication that requires prompt and aggressive treatment.[ic.steadyhealth.com]
  • Treatment for dermal exposure includes decontamination using soap and water or a hypochlorite ( bleach ) solution, which deactivates Ricin. In case of aerosol inhalation, treatment is the administration of oxygen, intubation, and ventilation.[science.jrank.org]
  • Medical Treatment Regardless of how you were exposed, treatment will mainly be supportive since there is no antidote or vaccine for ricin. If exposure is from inhaling the ricin, you may need assistance with breathing.[webmd.com]

Prognosis

  • Prognosis If death occurs it is usually within 36-72 hours of exposure. If the victim survives 5 days, death is unlikely.[patient.info]
  • Future: Prognosis Other diagnoses Differential diagnosis Additional or combination diagnoses Synergism Combined effects of multiple exposures VII.[fpnotebook.com]

Epidemiology

  • Al-Saif pp. 283–287 Abstract Full text PDF Abstract Epidemiological, clinical, and biochemical characteristics of Saudi patients with nonalcoholic fatty liver disease: a hospital-based study Waleed Al-hamoudi, Mohamed El-Sabbah, Safiyya Ali, Mansour Altuwaijri[annsaudimed.net]
Sex distribution
Age distribution

Pathophysiology

  • Although it has been used as a means of assassinating individuals, this would make it difficult to use as an agent of mass warfare. [ 2 ] Pathophysiology Ricin is a toxalbumin that can be extracted from the seeds of the plant.[patient.info]

Prevention

  • Prevention The only effective prevention against the effects of an attack with ricin is avoidance; unfortunately, no antidote or vaccine exists. Currently, studies are ongoing to find possible vaccines and ricin inhibitors.[webmd.com]
  • All About Poisoning • Centers for Disease Control and Prevention[cnn.com]
  • Registry (ATSDR) (1-888-422-8737) Source: Adapted from Centers for Disease Control and Prevention Facts About Ricin () , October 2003.[health.ny.gov]
  • Protective masks, which are effective in preventing toxicity, should be used when an overt aerosol attack is suspected.[emedicine.medscape.com]

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