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[1]
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
- Sympathetic crashing acute pulmonary edema (SCAPE)
- Immersion pulmonary edema
- Hantavirus pulmonary syndrome
- Missed dialysis in kidney failure
- Naloxone reversal
Bioterrorism Agents[2]
Evaluation
- Chest x-ray = bilateral infiltrates (pulmonary edema)
- Multi-organ failure occurred with a prominently elevated white blood cell count
Management
- Supportive
Disposition
- Admit
See Also
External Links
References
- Clark SB, Soos MP. Noncardiogenic Pulmonary Edema. In: StatPearls. Treasure Island (FL): StatPearls Publishing; October 1, 2020.
- https://www.niaid.nih.gov/topics/biodefenserelated/biodefense/pages/cata.aspx Accessed 02/26/16
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