CBRNE - Ricin Clinical Presentation

  • Author: Ferdinando L Mirarchi; Chief Editor: Robert G Darling, MD, FACEP   more...
 
Updated: Jun 7, 2010
 

History

  • In the case of an isolated attack such as an assassination attempt, no historical markers may be present.
  • A victim may relate the pain of an antecedent injection, but this may be overlooked during the history.
  • A patient is unlikely to be aware of contamination of ingested foods or beverages.
  • If a number of patients are affected simultaneously, by either ingestion or inhalation, the subsequent cluster of patients presenting with similar symptoms over a brief time may alert an astute clinician to the possibility of an intentional act. This is especially true in the case of an inhalation incident (ingestion initially may mimic food poisoning).
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Physical

Perform a complete physical examination with any exposure.

  • In parenteral exposure, inspect the site for induration, erythema, and the possibility of a retained foreign body. These physical findings may be present prior to or at the time of systemic manifestations.
  • In aerosol exposure, the presentation is that of a rapidly progressive acute lung injury, with findings consistent with the stage of progression from a physical examination with normal findings through hypoxia, cyanosis, labored breathing, tachypnea, tachycardia, and progressive respiratory failure.
  • In GI exposure, physical examination should be consistent with that for gastroenteritis and volume depletion. If the dose was sufficient and the disease had progressed, frank hematemesis and/or bloody diarrhea or melena may be present.
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Contributor Information and Disclosures
Author

Ferdinando L Mirarchi  DO, Medical Director and Director of Operations, Department of Emergency Medicine, UPMC-Hamot, Academic Core Faculty for Hamot Medical Center, Emergency Medicine Residency Program, Lake Erie College of Osteopathic Medicine

Ferdinando L Mirarchi is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, and Emergency Medicine Residents Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Jerry L Mothershead, MD  Medical Readiness Consultant, Medical Readiness and Response Group, Battelle Memorial Institute; Advisor, Technical Advisory Committee, Emergency Management Strategic Healthcare Group, Veteran's Health Administration; Adjunct Associate Professor, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences

Jerry L Mothershead, MD is a member of the following medical societies: American College of Emergency Physicians and National Association of EMS Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert G Darling, MD, FACEP  Adjunct Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Associate Director, Center for Disaster and Humanitarian Assistance Medicine

Robert G Darling, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Telemedicine Association, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Michael P Allswede, DO, to the development and writing of this article.

References

  1. CDC and Public Health Training Network. Recognition, Management and Surveillance of Ricin-Associated Illness [Web cast script]. December 30, 2003. [Full Text].

  2. CNN.com. Timeline: UK ricin terror probe. January 23, 2003. [Full Text].

  3. Balint GA. Ricin: the toxic protein of castor oil seeds. Toxicology. Mar 1974;2(1):77-102. [Medline].

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

  5. Ellenhorn MJ, Barceloux DG. Ornamental beans. In: Medical Toxicology Diagnosis and Treatment of Human Poisoning. 1988:1225-27.

  6. FBI. Federal Bureau of Investigations Web Page. Available at www.fbi.gov. Accessed 2000.

  7. Franz D, USAMRIID. Defense against toxic weapons. In: US Army Medical Research Material Command. 1997.

  8. Kopferschmitt J, Flesch F, Lugnier A, et al. Acute voluntary intoxication by ricin. Hum Toxicol. Apr 1983;2(2):239-42. [Medline].

  9. Kortepeter MG, Parker GW. Potential biological weapons threats. Emerg Infect Dis. Jul-Aug 1999;5(4):523-7. [Medline].

  10. Meselson M, Guillemin J, Hugh-Jones M, et al. The Sverdlovsk anthrax outbreak of 1979. Science. Nov 18 1994;266(5188):1202-8. [Medline].

  11. Shih RD, Goldfrank LR. Plants. In: Goldfrank's Toxicologic Emergencies. 6th ed. 1998:1254-55.

  12. US Medical Research Institute of Infectious Diseases. Medical Management of Biocasualities Handbook. 1998.

  13. Zilinskas RA. Iraq's biological weapons. The past as future?. JAMA. Aug 6 1997;278(5):418-24. [Medline].

 
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