TOXBASEŽ - Updated 10/01

 

Type of product:

Ricin is a toxalbumin extracted from the beans of the castor oil plant. It inhibits protein synthesis resulting in cell death.

 

Toxicity:

Ricin is poorly absorbed following ingestion. Ricin is particularly toxic if injected. The fatal dose by injection is thought to be around one microgram/kg body weight. Ricin has potential use in chemical warfare in aerosol form (it is non volatile). Absorption may also occur through abraded skin.

 

Features:

There may be a latent period of up to 3 days before symptoms appear after exposure by any route. Ingestion causes irritation of the oropharynx, severe vomiting, abdominal pain and diarrhoea, and possibly haematemesis or melaena. This may result in tachycardia, dehydration and thirst, fever and prostration.

Bloody diarrhoea, vomiting and abdominal pain may occur after exposure by any route. Eye rritation, conjunctivitis, miosis, mydriasis and optic nerve damage may occur.

Abnormal liver function tests, pulmonary oedema, pneumonia, ARDS, convulsions and CNS depression are possible. Renal impairment, proteinuria and haematuria may occur. In severe cases haemolytic anaemia may develop with subsequent acute renal failure secondary to haemoglobin precipitation in kidney tubules. Death may be due to multi-organ failure.

Allergic responses have been reported following exposure to castor oil beans.

 

Management:

AVOID CONTAMINATING YOURSELF
Ingestion
The benefit of gastric decontamination is uncertain but in view of potential hazard this should be considered.
1. Give activated charcoal (50 g for adults; 10-15 g for children).

2. Alternatively consider gastric lavage in adults within 1 hour.

3. Observation for at least 6 hours after ingestion. Advise patients to return if symptoms develop after discharge.

4. Monitor pulse, blood pressure and urine output. Measure FBC and U&Es.

5. .Monitor renal function and treat failure conventionally.

6. Other measures as indicated by the patient's clinical condition.

7. Plasmapheresis will remove circulating free haemoglobin and red cell fragments and is indicated if haemolysis is severe.

 

Aerosol inhalation

AVOID CONTAMINATING YOURSELF
Inhalation
1. Remove from exposure and give oxygen if necessary.

2. Maintain a clear airway and adequate ventilation if indicated.

3. All patients should be observed in hospital for at least 24 hours.

4. Perform chest X-ray if symptomatic.

5. Manage bronchospasm with bronchodilators.

6. Treat pulmonary oedema with continuous positive airway pressure (CPAP) or in severe cases with IPPV and PEEP.

7. Other measures as indicated by the patient's clinical condition.