eMedicine Specialties > Emergency Medicine > Warfare - Chemical, Biological, Radiological, Nuclear and Explosives

CBRNE - Ricin: Follow-up

Author: Ferdinando L Mirarchi, DO, Medical Director, Department of Emergency Medicine, Hamot Medical Center; Assistant Clinical Professor, Department of Emergency Medicine, Drexel University School of Medicine
Contributor Information and Disclosures

Updated: Feb 14, 2008

Follow-up

Further Inpatient Care

  • Perform adequate volume resuscitation of patients. First treat hypotension with isotonic fluids and packed red blood cells as needed. Use a pressor-type agent such as dopamine or norepinephrine when needed.

Deterrence/Prevention

  • The only effective treatment or prevention against a biological attack with ricin is prophylaxis; unfortunately, no prophylaxis exists. Currently, investigations are ongoing with candidate vaccines and ricin inhibitors. Human vaccines are under investigation and show promise but are still unavailable at this time. In an aerosol attack, protective masks are effective in preventing toxicity and should be used.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Investigate any ricin exposure that involves multiple victims. Weaponized use of ricin is a reportable offense and mandates reporting to local and federal authorities.

Special Concerns

  • Conclusion: Although ricin is not the ideal biological warfare agent, it remains a threat. It is widely available and easily produced. It is not the ideal agent of choice for an aerosol attack, but it is a major concern as a food and water contaminant. With the increasing number of biological threats, hoaxes, and "how to" Internet resources available, this threat has the potential to become reality. Therefore, the emergency physician must be familiar with its characteristics. Treatment is supportive, and no antidote or approved vaccine is available.
 
Acknowledgments

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.



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Follow-up: CBRNE - Ricin
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References
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References

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

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  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.

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Further Reading

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Keywords

Ricinus communis, toxin, agent of biological warfare, weapon of mass destruction, WMD, beans of castor plant, castor beans, food contaminant, water contaminant, hematemesis, bloody diarrhea, melena, food poisoning, hypoxia, cyanosis, labored breathing, tachypnea, tachycardia, progressive respiratory failure, ricin, biological warfare agent, terrorism

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Contributor Information and Disclosures

Author

Ferdinando L Mirarchi, DO, Medical Director, Department of Emergency Medicine, Hamot Medical Center; Assistant Clinical Professor, Department of Emergency Medicine, Drexel University School of Medicine
Ferdinando L Mirarchi, DO is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Emergency Medicine Residents Association
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
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

CME Editor

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, Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; 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, and Association of Military Surgeons of the US
Disclosure: Nothing to disclose.

 
 
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