Ricin

Background

• Found in castor beans from the plant Ricinus communis
  • A residual product of the production of castor oil (if properly prepared, does not contain the toxin)
• Exposure can be parenteral, inhaled, or ingested

Clinical Features

• First symptoms occur 3-12 hours after exposure
• Acute lung injury
  • Fever, cough, shortness of breath, and nausea
• Death 36-48 hours after exposure
  • Alveolar flooding, fibropurulent pneumonia, and necrotizing tracheitis

Differential Diagnosis

Pulmonary Edema Types

Pulmonary capillary wedge pressure <18 mmHg differentiates noncardiogenic from cardiogenic pulmonary edema

• Cardiogenic pulmonary edema
• Noncardiogenic pulmonary edema
  • Negative pressure pulmonary edema
    • Upper airway obstruction
    • Reexpansion pulmonary edema
    • Strangulation
  • Neurogenic causes
    • Seizure
    • Head trauma
    • Subarachnoid hemorrhage
    • Electrocution
  • Iatrogenic fluid overload
    • Multiple blood transfusions
    • IV fluid
    • Inhalation injury
    • Pulmonary contusion
    • Aspiration pneumonia and pneumonitis
  • Other
    • High altitude pulmonary edema
    • Hypertensive emergency
    • ARDS
    • Flash pulmonary edema
    • Immersion pulmonary edema
    • Hantavirus pulmonary syndrome
    • Missed dialysis in kidney failure
    • Naloxone reversal

Diagnosis

• Chest x-ray = bilateral infiltrates (pulmonary edema)
• Multi-organ failure occurred with a prominently elevated white blood cell count

References

• Lutwick LI,Gradon J, Zellen J: Category B Biotoxins. In Lutwick LI, Lutwick SM (eds), Beyond Anthrax: Bioterror - The Weaponization of Infectious Diseases. Springer-Humana, New York, 2009, New York, pp. 181-206: