Castor Bean and Jequirity Bean Poisoning Workup

  • Author: William Gluckman, DO, MBA, FACEP; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Apr 19, 2011
 

Laboratory Studies

  • Laboratory evaluation should initially include CBC count with differential, basic metabolic profile (electrolyte levels), and liver function tests. Coagulation studies may be necessary if the gastroenteritis becomes hemorrhagic.
  • Critically ill and hypotensive patients and those that meet systemic inflammatory response/sepsis criteria should have an ABG and lactate and cortisol levels measured.
  • An enzyme-linked immunoassay (ELISA) can detect ricin in human urine and serum at concentrations of 100 pg/mL or greater. Testing for ricin can be done by polymerase chain reaction (PCR) at a regional public health center laboratory by collecting 25 mL of urine.
  • Additional analytic methods may be available for ricin detection through the US Army Medical Research Institute for Infectious Diseases and the Centers for Disease Control and Prevention (CDC).
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Imaging Studies

  • Imaging studies are not necessary because the beans generally are not detectable by plain radiography.
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Procedures

Whole bowel irrigation (WBI) has been suggested as a possible treatment to ensure rapid and complete decontamination of the GI tract; however, the potential benefit (if any) remains unproven.

Consult with a medical toxicologist at the nearest regional poison control center before undertaking WBI.

WBI is accomplished by a continuous instillation of a polyethylene glycol electrolyte lavage solution through the gastrointestinal tract until the effluent from the rectum is clear.

Inserting a nasogastric tube and setting a continuous flow rate will accomplish WBI best.

Rates of WBI vary according to age.

  • Children aged 0-6 years: Flow rate is 500 mL/h.
  • Children aged 6-12 years: Flow rate is 1000 mL/h.
  • Children older than 12 years: Flow rate is 1500-2000 mL/h.
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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;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

  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. 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].

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

  7. 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].

  8. Jang DH, Hoffman RS, Nelson LS. Attempted suicide, by mail order: Abrus precatorius. J Med Toxicol. Dec 2010;6(4):427-30. [Medline].

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

  10. 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].

  11. 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].

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

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

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

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

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

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

  18. 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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Castor bush.
Castor beans.
Jequirity bush.
Jequirity beans.
 
 
 
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