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Castor Bean and Jequirity Bean Poisoning Clinical Presentation

  • Author: William Gluckman, DO, MBA, FACEP; Chief Editor: Timothy E Corden, MD  more...
 
Updated: Apr 29, 2015
 

History

Assess the usual significant features that are associated with toxic environmental exposures. This includes the following:

  • Identification of substance
  • Time and duration of exposure
  • Symptoms
  • Treatment thus far
  • Associated injuries
  • Preexisting conditions

Identification

Ask the parents to bring in a sample of the bean, if it is possible. Having the exact bean greatly aids in the identification process. Knowing that beans are often known by various names, both common and scientific, is important.

Time and duration of exposure

Determine whether the child chewed or swallowed any beans.

Symptomatology

Following ingestion of jequirity beans, a latent period of about 3 days occurs, and symptoms may persist more than 10 days later. Patient may present with nausea, vomiting, diarrhea, abdominal cramps, hematemesis, and melena. In some cases, acute renal failure and hepatotoxicity may occur.

Drowsiness and seizures have been reported after jequirity bean ingestion. If eye contact is made, the patient may report eye irritation and blindness. Skin contact may result in a rash.

Following ingestion of castor beans, the patient may become symptomatic from 8-24 hours after exposure. The clinical picture may appear very similar to jequirity bean ingestion, with GI symptoms that can progress to hypotension, liver and renal failure, and death.

Inhalation of castor bean toxin can cause illness within 8 hours. Symptoms include cough, dyspnea, arthralgias, fever, respiratory distress, and death. Injection of ricin causes symptoms within 6 hours, which may include weakness and myalgias with progression of the illness to fever, hypotension, multiorgan failure, and death.

Prior treatment

Determine if any treatment has been administered to the child prior to presentation.

Associated injuries

Inquire about any other potential exposures or injury.

Preexisting conditions

Inquire about past medical history, medications, and allergies.

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Physical

See the list below:

  • Assess airway patency. It is extremely uncommon to have any oral or upper airway swelling of sufficient magnitude to cause airway compromise. Breathing usually is unaffected. Circulation may become affected as shock develops, secondary to severe gastroenteritis.
  • Patients may develop severe cutaneous hypersensitivity or systemic allergic reactions. An urticarial, immunoglobulin E–mediated allergic reaction may occur with the development of tongue or facial swelling, bronchospasm, and acute upper airway obstruction.
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Causes

See the list below:

  • Both castor and jequirity beans are commonly encountered as ornamental beans or seeds.
  • Castor and jequirity beans are commonly used as prayer beads, bracelets, or necklaces.
  • Castor and jequirity beans are also used as the seeds that rattle in maracas.
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Contributor Information and Disclosures
Author

William Gluckman, DO, MBA, FACEP President and CEO, FastER Urgent Care

William Gluckman, DO, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Association for Physician Leadership

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Jeffrey R Tucker, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center

Disclosure: Received salary from Merck for employment.

Chief Editor

Timothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, Wisconsin Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Michael E Mullins, MD Assistant Professor, Division of Emergency Medicine, Washington University in St Louis School of Medicine; Attending Physician, Emergency Department, Barnes-Jewish Hospital

Michael E Mullins, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians

Disclosure: Received stock ownership from Johnson & Johnson for none; Received stock ownership from Savient Pharmaceuticals for none.

Acknowledgements

Gregory S Sugalski, MD Staff Physician, Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey Hospital

Gregory S Sugalski, MD is a member of the following medical societies: American Medical Association and Emergency Medicine Residents Association

Disclosure: Nothing to disclose.

Acknowledgments

The authors would like to thank John Kashani, DO, FACEP, for his review and comments.

References
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  2. Bronstein AC, Spyker DA, Cantilena LR Jr, Green J, Rumack BH, Heard SE. 2006 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS). Clin Toxicol (Phila). 2007 Dec. 45(8):815-917. [Medline].

  3. Røen BT, Opstad AM, Haavind A, Tønsager J. Serial ricinine levels in serum and urine after ricin intoxication. J Anal Toxicol. 2013 Jun. 37(5):313-7. [Medline].

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  13. Navarro-Rouimi R, Charpin D. Anaphylactic reaction to castor bean seeds. Allergy. 1999 Oct. 54(10):1117. [Medline].

  14. Olsnes S. The history of ricin, abrin and related toxins. Toxicon. 2004. Sep 15;44(4):361-70. [Medline].

  15. Palatnick W, Tenenbein M. Hepatotoxicity from castor bean ingestion in a child. J Toxicol Clin Toxicol. 2000. 38(1):67-9. [Medline].

  16. Rauber A. Plantlore revisited. J Toxicol Clin Toxicol. 1999. 37(4):521-4. [Medline].

  17. Schwenk M, Kluge S, Jaroni H. Toxicological aspects of preparedness and aftercare for chemical-incidents. Toxicology. 2005. 214(3):232-48. [Medline].

  18. Spivak L, Hendrickson RG. Ricin. Crit Care Clin. 2005. Oct;21(4):815-24, viii. [Medline].

  19. Vitetta ES, Smallshaw JE, Coleman E, et al. A pilot clinical trial of a recombinant ricin vaccine in normal humans. Proc Natl Acad Sci USA. 2006. 103(7):2268-73. [Medline].

 
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