eMedicine Specialties > Emergency Medicine > Toxicology

Plant Poisoning, Castor Bean and Jequirity Bean: Follow-up

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; Attending Emergency Physician, St Joseph's Regional Medical Center; President and CEO, FastER Urgent Care
Coauthor(s): Gregory S Sugalski, MD, Staff Physician, Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey Hospital
Contributor Information and Disclosures

Updated: Nov 21, 2008

Follow-up

Further Inpatient Care

  • Whole bowel irrigation (WBI) is continued until the rectal effluent is clear or all of the beans have been recovered.
  • Continue intravenous (IV) fluids at a rate that maintains adequate hydration and replacement of electrolytes.
  • All symptomatic patients should be admitted to the hospital. Clinical course after ingestion and inhalation typically progresses over 4-36 hours, and monitoring in an ICU may be warranted.

Further Outpatient Care

  • Maintain adequate hydration
  • Antispasmodics, such as loperamide, are contraindicated.

Transfer

  • Transfer children with severe systemic toxicity to a center that is capable of handling critically ill children.
  • Transfer should occur after the child has been stabilized and whole bowel decontamination has been initiated.

Deterrence/Prevention

  • Keep all potentially poisonous and injurious plants and plant-related products away from children.
  • Homes should be purged of all potentially toxic plant items, just as they are for medications and cleaning supplies.
  • Specifically instruct children to never eat plants, beans, or wild berries.
  • Vaccine development has been attempted in animal studies, with evidence that either active immunization or passive prophylaxis is effective against IV or intraperitoneal intoxication only if given within a few hours of exposure. Vaccination is ineffective against aerosolized forms of the toxin.
  • Ricin toxin vaccine (RiVax; DOR BioPharma, Miami, FL) has been shown in one small pilot study to be safe; it elicited ricin neutralizing antibodies, but larger studies are needed.3

Complications

Prognosis

  • Prognosis for patients who develop symptoms is generally good with appropriate fluid management (and possibly with continuous WBI).
  • Studies are limited, and accurate statistics are not known.

Patient Education

  • Instruct parents or guardians to childproof homes from all potentially toxic plants and plant-related items.

Miscellaneous

Medicolegal Pitfalls

  • Failure to identify the correct exposure
  • Failure to provide adequate decontamination in a timely manner
  • Failure to maintain adequate circulation and normal electrolyte levels

Special Concerns

  • Electrolyte disturbance
  • Shock
  • Hemorrhagic gastroenteritis
  • Multisystem organ failure
  • Other concerns
    • In the face of credible threats, clinicians should consider ricin poisoning in patients who present with GI or respiratory illness. Be sure to notify poison control centers, public health, and local law enforcement agencies.
    • Clinicians must have a low threshold of suspicion for patients who present with nonspecific systemic illness, especially when a large number of patients with similar symptoms are present.
 
Acknowledgments

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



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References
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References

  1. Audi J, Belson M, Patel M, et al. Ricin poisoning: a comprehensive review. JAMA. 2005;Nov 9;294(18):2342-51. [Medline].

  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). Dec 2007;45(8):815-917. [Medline].

  3. Doan LG. Ricin: mechanism of toxicity, clinical manifestations, and vaccine development. A review. J Toxicol Clin Toxicol. 2004;42(2):201-8. [Medline].

  4. Challoner KR, McCarron MM. Castor bean intoxication. Ann Emerg Med. Oct 1990;19(10):1177-83. [Medline].

  5. Fernando C. Poisoning due to Abrus precatorius (jequirity bean). Anaesthesia. Dec 2001;56(12):1178-80. [Medline].

  6. 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].

  7. Kinamore PA, Jaeger RW, de Castro FJ. Abrus and ricinus ingestion: management of three cases. Clin Toxicol. Oct 1980;17(3):401-5. [Medline].

  8. 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].

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

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

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

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

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

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

  15. 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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Further Reading

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Keywords

castor bean, caster bean plant, caster bean seeds, caster bean poison, jequirity bean, ricinus communis, terrorism, ricin, gastroenteritis

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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; Attending Emergency Physician, St Joseph's Regional Medical Center; 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 Society for Academic Emergency Medicine
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.

Medical Editor

Michael E Mullins, MD, Assistant Professor, Department of Emergency Medicine, Washington University School of Medicine
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

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Jeffrey R Tucker, MD, Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut and Connecticut Children's Medical Center
Jeffrey R Tucker, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Pediatrics, and Massachusetts Medical Society
Disclosure: Merck Salary Employment

CME Editor

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.

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