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Ricin Poisoning after Oral Ingestion of Castor Beans: A Case Report and Review of the Literature and Laboratory Testing.
J Emerg Med. 2017 Nov; 53(5):e67-e71.JE

Abstract

BACKGROUND

Ricin is a protein toxin derived from the castor bean plant Ricinus communis. Several cases secondary to its consumption have been published and, more recently, its use as a potential bioterrorism agent has also been reported. Oral absorption of ricin is highly erratic, leading to a wide spectrum of symptoms. In addition, conventional urine drug screening tests will not be able to detect this compound, posing a diagnostic challenge.

CASE REPORT

A male teenager intended to die by ingesting 200 castor beans after mixing and blending them with juice. Eight hours later, he presented with weakness, light-headedness, nausea, and vomiting and sought medical treatment. The patient was admitted and treated conservatively. An immune-based standard urine toxicology drug screen panel was reported as negative. A comprehensive untargeted urine drug screen test showed the presence of ricinine, a surrogate marker of ricin intoxication. He was transferred to the psychiatric service 3 days after admission. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the importance of knowing the peculiar pharmacokinetic properties of ricin after oral ingestion of castor beans and toxin release through mastication. Emergency physicians should be aware that oral absorption of ricin is dependent on several factors, such type and size of seeds and the geographic harvesting region, making it extremely difficult to estimate its lethality based solely on the number of ingested beans. Finally, comprehensive untargeted urine drug screening testing is highly valuable as a diagnostic tool in this context.

Authors+Show Affiliations

Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Clinical Laboratories, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania.Division of Medical Toxicology, Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Clinical Laboratories, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Clinical Laboratory, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

28987302

Citation

Lopez Nunez, Oscar F., et al. "Ricin Poisoning After Oral Ingestion of Castor Beans: a Case Report and Review of the Literature and Laboratory Testing." The Journal of Emergency Medicine, vol. 53, no. 5, 2017, pp. e67-e71.
Lopez Nunez OF, Pizon AF, Tamama K. Ricin Poisoning after Oral Ingestion of Castor Beans: A Case Report and Review of the Literature and Laboratory Testing. J Emerg Med. 2017;53(5):e67-e71.
Lopez Nunez, O. F., Pizon, A. F., & Tamama, K. (2017). Ricin Poisoning after Oral Ingestion of Castor Beans: A Case Report and Review of the Literature and Laboratory Testing. The Journal of Emergency Medicine, 53(5), e67-e71. https://doi.org/10.1016/j.jemermed.2017.08.023
Lopez Nunez OF, Pizon AF, Tamama K. Ricin Poisoning After Oral Ingestion of Castor Beans: a Case Report and Review of the Literature and Laboratory Testing. J Emerg Med. 2017;53(5):e67-e71. PubMed PMID: 28987302.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ricin Poisoning after Oral Ingestion of Castor Beans: A Case Report and Review of the Literature and Laboratory Testing. AU - Lopez Nunez,Oscar F, AU - Pizon,Anthony F, AU - Tamama,Kenichi, Y1 - 2017/10/04/ PY - 2017/05/11/received PY - 2017/07/22/revised PY - 2017/08/08/accepted PY - 2017/10/11/pubmed PY - 2018/7/17/medline PY - 2017/10/9/entrez KW - castor bean KW - clinical chemistry tests KW - ricin KW - ricinine KW - toxicology SP - e67 EP - e71 JF - The Journal of emergency medicine JO - J Emerg Med VL - 53 IS - 5 N2 - BACKGROUND: Ricin is a protein toxin derived from the castor bean plant Ricinus communis. Several cases secondary to its consumption have been published and, more recently, its use as a potential bioterrorism agent has also been reported. Oral absorption of ricin is highly erratic, leading to a wide spectrum of symptoms. In addition, conventional urine drug screening tests will not be able to detect this compound, posing a diagnostic challenge. CASE REPORT: A male teenager intended to die by ingesting 200 castor beans after mixing and blending them with juice. Eight hours later, he presented with weakness, light-headedness, nausea, and vomiting and sought medical treatment. The patient was admitted and treated conservatively. An immune-based standard urine toxicology drug screen panel was reported as negative. A comprehensive untargeted urine drug screen test showed the presence of ricinine, a surrogate marker of ricin intoxication. He was transferred to the psychiatric service 3 days after admission. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the importance of knowing the peculiar pharmacokinetic properties of ricin after oral ingestion of castor beans and toxin release through mastication. Emergency physicians should be aware that oral absorption of ricin is dependent on several factors, such type and size of seeds and the geographic harvesting region, making it extremely difficult to estimate its lethality based solely on the number of ingested beans. Finally, comprehensive untargeted urine drug screening testing is highly valuable as a diagnostic tool in this context. SN - 0736-4679 UR - https://wwww.unboundmedicine.com/medline/citation/28987302/Ricin_Poisoning_after_Oral_Ingestion_of_Castor_Beans:_A_Case_Report_and_Review_of_the_Literature_and_Laboratory_Testing_ DB - PRIME DP - Unbound Medicine ER -