TOXIC SYNDROME DESCRIPTION
Ricin or Abrin Poisoning
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Summary statement
Ricin is a potent biological toxin that is derived from castor beans. Its mechanism of action in the body is inhibition of protein synthesis. Clinical manifestations are dependent on the route of exposure. Ingestion of ricin typically leads to profuse vomiting and diarrhea followed by multisystem organ failure and possibly death within 36 to 72 hours of exposure. Inhalation of ricin typically leads to respiratory distress, fever, and cough followed by the development of pulmonary edema, hypotension, respiratory failure, and possibly death within 36 to 72 hours.
The amount and route of the exposure to ricin and the premorbid condition of the person exposed will contribute to the time of onset and the severity of illness. For example, the inhalation of ricin would be expected to lead to a quicker onset of poisoning and to cause a more rapid progression of poisoning compared with the ingestion of ricin, given the same exposure amount.
Signs and symptoms of exposure
The following is a more comprehensive list of signs and symptoms that may be encountered in a person exposed to ricin. The list does not convey prioritization or indicate specificity. Also, partial presentations (an absence of some of the following signs/symptoms) do not necessarily imply less severe disease.
Gastrointestinal
- Abdominal pain
- Vomiting
- Diarrhea (nonbloody or bloody)
- Abnormal liver function tests
- Multiple ulcerations and hemorrhages of gastric and small-intestinal mucosa on endoscopy
Respiratory
- Cough
- Chest tightness
- Dyspnea
- Hypoxemia
- Noncardiogenic pulmonary edema
Skin and mucous membranes
- Redness and pain of eyes and skin
General
- Fever
- Fatigue
- Weakness
- Muscle pain
- Dehydration
Other organs
- Seizures (uncommon)
- Cardiovascular collapse (hypovolemic shock)
Laboratory (nonspecific)
- Metabolic acidosis
- Increased liver function tests
- Increased renal function tests
- Hematuria
- Leukocytosis (two- to five-fold higher than normal value)
Note: The actual clinical manifestations of a ricin or abrin exposure may be more variable than the syndrome described above.
Differential diagnosis
Inhalation:
- Staphylococcal enterotoxin B
- Exposure to pyrolysis byproducts of organofluorines (Teflon, Kevlar)
- Oxides of nitrogen
- Phosgene
- Ozone
Ingestion:
- Enteric pathogens
- Mushrooms
- Caustics
- Iron
- Arsenic
- Colchicine
This toxic
syndrome description is based on CDC’s best current information.
It may be updated as new information becomes available.
Page last reviewed February 22, 2006
Page last modified March 28, 2005