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Ricin Poisoning

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Last Updated: 02 July 2021

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Author Affiliations: Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Environmental Hazards and Health Effects, Health Studies Branch and National Center for Environmental Health, Division of Laboratory Sciences, Emory University, Department of Emergency Medicine and Georgia POISON Control Center, Section of Toxicology, Atlanta. Dr Audi is now at Nebraska Regional POISON Center and Department of Surgery of University of Nebraska Medical Center, Omaha. The recent discovery of RICIN, deadly biologic toxin, at the South Carolina postal facility, White House mail facility, and the US senators office has raised concerns among public health officials, physicians, and citizens. Ricin is one of the most potent and lethal substances know, particularly when inhale. The ease with which native plants can be obtained and toxin extract make RICIN an attractive weapon. Objectives To summarize literature on RICIN poisoning and provide recommendations based on our best professional judgment for clinicians and public health officials that are faced with deliberate release of RICIN into the environment. Literature Acquisition Using PubMed, we search MEDLINE and OLDMEDLINE databases. The Chemical and Biological Information Analysis Center database was searched for historical and military literature relating to RICIN Toxicity. Book chapters, unpublished reports, monographs, relevant news reports, and Web material were also reviewed to find nonindexed articles. Results Most literature on RICIN poisoning involves castor bean ingestion and experimental animal research. Aerosol release of RICIN into the environment or adulteration of food and beverages are pathways to exposure likely to be exploit. Symptoms after ingestion are nonspecific and may include nausea, vomiting, diarrhea, and abdominal pain and may progress to hypotension, liver failure, renal dysfunction, and death due to multiorgan failure or cardiovascular collapse. Inhalation of RICIN is expected to produce cough, dyspnea, arthralgia and fever and may progress to respiratory distress and death, with few other organ system manifestations. Biological analytic methods for detecting RICIN exposure are undergoing investigation and may soon be available through reference laboratories. Testing of environmental samples is available through federal reference laboratories. Currently, no antidote, vaccine, or other specific effective therapy is available for RICIN poisoning or prevention. Prompt treatment with supportive care is necessary to limit morbidity and mortality. Conclusion Health care workers and public health officials should consider RICIN poisoning in patients with gastrointestinal or respiratory tract illness in setting credible threat. Poison Control Centers and public health authorities should be notified of any known illness associated with RICIN exposure. Growing awareness and concern about RICIN, potent biologic toxin, as a possible terrorist weapon has necessitated comprehensive review of this POISON. 1 Centers for Disease Control and Prevention categorizes RICIN as a Category B agent, as it is moderately easy to disseminate, resulting in low mortality but moderate to high morbidity, and requires specific enhancement of CDCs diagnostic and Disease surveillance capacity. 2 Such agents are not routinely encounter, so heightened awareness in the health care community and strong public health infrastructure are necessary for detection and response.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

The Facts About Ricin

Accidental exposure to ricin is highly unlikely. It would take a deliberate act to use it as poison. People can be poisoned by breathing in ricin mist or powder. People can also be poisoned by swallowing ricin - contaminated food or water. Ricin may enter the body through skin when combined with certain chemicals or if skin is damage. Pellets of ricin, or ricin dissolved in liquid, can also be injected into people's bodies. Depending on route of exposure, amount of ricin that would fit on the head of a pin could be enough to kill an adult. Because ricin is a chemical poison, illness it causes cannot be spread from person - to - person. However, contact with ricin - contaminated surfaces or people may transfer this poison and cause illness.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

CASE

A 42 - year - old male Saudi patient presented to the emergency department with a 12 - hour history of epigastric pain, nausea, repeated attacks of vomiting, chest tightness, and mild nonproductive cough. These symptoms were preceded by a 5 - day history of constipation for which the patient ingest large amount of mixture of herbal medicine preparation 2 days prior to his admission. The review of systems was unremarkable. He had no history of any medical illnesses and medication use except for herbal medicine. Initial examination showed mild elevation of temperature, with generalized abdominal tenderness and hyperactive bowel sounds. His respiratory system examination showed equal bilateral air entry and no added sounds. The rest of his systemic examinations were unremarkable. Laboratory investigations on admission show mild leukocytosis of 1410 9 / L, normal platelet count of 20010 9 / L, and normal hemoglobin level of 15. 8 g / dL. Liver enzymes initially showed mild to moderate elevation of alanine transaminase 86 U / L, aspartate transaminase 252 U / L, and serum lactate dehydrogenase 281 U / L, and renal function was normal. Initial coagulation profile was impaired as documented by prolonged prothrombin time and prolonged activate partial thromboplastin time. The electrocardiogram showed right bundle branch block, and the chest radiograph was normal. After 4 hours of admission, abdominal pain become worse, and patient start showing subcutaneous bleeding at intravenous sites and upper gastrointestinal bleeding, manifest as hematamesis. The patient was managed by intravenous fluid therapy, fresh frozen plasma and platelet transfusion, and gastric decontamination with activated charcoal. Gastrointestinal consultation was requested in which endoscopy was planned after stabilization of patient, but was not performed because of rapid deterioration of patient. On the second day after admission, his liver enzymes increased to a level of 5980 U / L for ALT and 7010 U / L for AST. Serum albumin was 31 g / L, total protein was 59 g / L, and platelet count dropped to 8510 9 / L. His renal function also deteriorate, elevating creatinine level to 150 Umol / L, and urea to 110 mmol / L. His blood and sputum cultures and sensitivity were negative for bacterial pathogens, and abdominal computerized tomography scan was normal. The patient was managed conservatively with supportive measures as maintained earlier; however, he remained persistently hypotensive, necessitating inotropic support. On 3 day,s he developed cardiopulmonary arrest and was resuscitate; however, he could not be revive. A sample of herbal medicine powder was sent to the university lab. Chemical contents were extracted by liquid chromatography / mass spectrometry technique, revealing the presence mainly of Ricin powder, 11 which was further identified by immuno - polymerase chain reaction assay 12 that confirmed the presence mainly of Ricin with no other significant contaminants. This finding could be implicated as cause of patients ' fulminant clinical course.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

DISCUSSION

Ricin is a toxin contained in seeds of castor oil plant. The plant is found primarily in Asia and Africa but has taken root in all temperate and subtropical regions around the world and is widely grown as garden ornamental. See image below. Ricin is present in all parts of plant but is most highly concentrated in beans or seeds. Beans are covered by hard, relatively impervious outer shell that must be chewed or broken in some way in order for toxalbumin to be released and, thus, present a toxic hazard. In addition, castor beans are notably antigenic and may cause severe cutaneous hypersensitivity and systemic reactions. Although castor beans are an uncommon cause of poisoning, they remain a concern because their toxin is among the most lethal naturally occurring toxins known today, is easily accessible, is inexpensive, and is easy to prepare;. Hence, it is attractive to terrorists. The Centers for Disease Control and Prevention classification scheme for major biological agents that terrorists could use to harm civilians categorizes Ricin as a category B agent because it is moderately easy to disseminate while causing moderate - to - high morbidity in humans. Ricin has been used in politically motivated assassination.S Indeed, Ricin has been used for homicidal purposes for centuries, although it has never been released or used in battle as a Biological weapon of War. Although Ricin is not an ideal biologic warfare agent, it remains a threat. It would not be the agent of choice for aerosol attack but remain major concern as food and water contaminant. With an increasing number of biologic threats, hoaxes, and how - to Internet resources available, this threat has potential to become reality. Therefore, it is essential for physicians to be familiar with diagnosis and treatment of poisonings due to Ricin. Exposure to Ricin can result in toxicity or allergic reactions. Clinical manifestations of Ricin toxicity depend on route of exposurethat is, respiratory, gastrointestinal, parenteral, or dermal and on delivery dose. For example, ingestion can produce delayed gastroenteritis, which may be severe and hemorrhagic. Other complications of Ricin toxicity include severe multisystem organ damage; shock, disseminated intravascular coagulation, seizures, coma, and death. Treatment of Ricin exposure is supportive; no antidote or approved vaccine is available. See 11 Common Plants that Can Cause Dangerous Poisonings, Critical Images slideshow, to help identify plant reactions and poisonings. For patient education resources, see First Aid and Injuries Center, as well as Biological Warfare, Ricin, and Personal Protective Equipment.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

What is ricin?

Ricin is a potent biological toxin derived from part of waste mash when beans from castor plant are processed during manufacture of castor oil. Ricin is toxalbumin, whose mechanism of action is inhibition of protein synthesis; cell death results from absence of proteins. It is classified as a Type 2 ribosome - inactivating protein. Depending on route of exposure, as little as 500 of ricin could be enough to kill an adult. A greater amount would be needed to cause death if ricin were ingest. It takes deliberate act to manufacture ricin to poison people. Ricin is one of the most toxic biological agents, known as a Category B bioterrorism agent and Schedule Number 1 chemical warfare agent.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

How ricin poisoning is treated

Emergency department management begins with universal precautions and ABCs; D may be added for decontamination. If history and presenting findings suggest that ingestion is possible, gut decontamination should be considered as well. Treatment depends on the route of exposure. Treatment is supportive, and no antidote for ricin is available. All symptomatic patients should be admitted to hospital. After ingestion and inhalation, clinical course typically progresses over 4 - 36 hours, and monitoring in intensive care unit may be warrant. Children with severe systemic toxicity should be transferred to a center capable of handling critically ill children. This should occur after the child has been stabilized and whole - bowel decontamination is initiate. Because there is no definitive antidote for ricin poisoning, only effective way of managing ricin toxicity is to prevent it. Candidate vaccines and ricin inhibitors are being investigated either as antidotes or as means of facilitating immunotoxin treatment. Some promising results have been obtain; however, vaccine trials still require additional testing for safety and efficacy.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Sources

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

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