Castor Bean and Jequirity Bean Poisoning Workup

Updated: Apr 29, 2015
  • Author: William Gluckman, DO, MBA, FACEP; Chief Editor: Timothy E Corden, MD  more...
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Workup

Laboratory Studies

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  • 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. [3]
  • 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

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  • 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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