Castor Bean and Jequirity Bean Poisoning Clinical Presentation

Author: William Gluckman, DO, MBA, FACEP; Chief Editor: Timothy E Corden, MD more...

Updated: Apr 19, 2011

What would you like to print?

History
Physical
Causes
Show All

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.

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.

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.

Proceed to Differential Diagnoses

Contributor Information and Disclosures

Author

William Gluckman, DO, MBA, FACEP Assistant Professor, Department of Surgery, Section of Emergency Medicine, University of Medicine and Dentistry of New Jersey, University Hospital;President and CEO, FastER Urgent Care

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

Disclosure: Nothing to disclose.

Coauthor(s)

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.

Specialty Editor Board

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 and American College of Emergency Physicians

Disclosure: Johnson & Johnson stock ownership None; Savient Pharmaceuticals stock ownership None

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: Merck Salary Employment

Paul D Petry, DO, FACOP, FAAP Consulting Staff, Freeman Pediatric Care, Freeman Health System

Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

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, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

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

References

Audi J, Belson M, Patel M, et al. Ricin poisoning: a comprehensive review. JAMA. 2005;Nov 9;294(18):2342-51. [Medline].
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). Dec 2007;45(8):815-917. [Medline].
Doan LG. Ricin: mechanism of toxicity, clinical manifestations, and vaccine development. A review. J Toxicol Clin Toxicol. 2004;42(2):201-8. [Medline].
Challoner KR, McCarron MM. Castor bean intoxication. Ann Emerg Med. Oct 1990;19(10):1177-83. [Medline].
Coopman V, De Leeuw M, Cordonnier J, Jacobs W. Suicidal death after injection of a castor bean extract (Ricinus communis L.). Forensic Sci Int. Aug 10 2009;189(1-3):e13-20. [Medline].
Fernando C. Poisoning due to Abrus precatorius (jequirity bean). Anaesthesia. Dec 2001;56(12):1178-80. [Medline].
Ferraz AC, Angelucci ME, Da Costa ML, et al. Pharmacological evaluation of ricinine, a central nervous system stimulant isolated from Ricinus communis. Pharmacol Biochem Behav. Jul 1999;63(3):367-75. [Medline].
Jang DH, Hoffman RS, Nelson LS. Attempted suicide, by mail order: Abrus precatorius. J Med Toxicol. Dec 2010;6(4):427-30. [Medline].
Kinamore PA, Jaeger RW, de Castro FJ. Abrus and ricinus ingestion: management of three cases. Clin Toxicol. Oct 1980;17(3):401-5. [Medline].
Krenzelok EP, Jacobsen TD. Plant exposures ... a national profile of the most common plant genera. Vet Hum Toxicol. Aug 1997;39(4):248-9. [Medline].
Lim H, Kim HJ, Cho YS. A case of ricin poisoning following ingestion of Korean castor bean. Emerg Med J. Apr 2009;26(4):301-2. [Medline].
Navarro-Rouimi R, Charpin D. Anaphylactic reaction to castor bean seeds. Allergy. Oct 1999;54(10):1117. [Medline].
Olsnes S. The history of ricin, abrin and related toxins. Toxicon. 2004;Sep 15;44(4):361-70. [Medline].
Palatnick W, Tenenbein M. Hepatotoxicity from castor bean ingestion in a child. J Toxicol Clin Toxicol. 2000;38(1):67-9. [Medline].
Rauber A. Plantlore revisited. J Toxicol Clin Toxicol. 1999;37(4):521-4. [Medline].
Schwenk M, Kluge S, Jaroni H. Toxicological aspects of preparedness and aftercare for chemical-incidents. Toxicology. 2005;214(3):232-48. [Medline].
Spivak L, Hendrickson RG. Ricin. Crit Care Clin. 2005;Oct;21(4):815-24, viii. [Medline].
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].