Treatment for Abrin Poisoning from Ratol (Ricinus communis) Ingestion
The treatment for abrin poisoning is primarily supportive care, including intravenous fluid resuscitation, anti-emetics for vomiting control, and possibly continuous renal replacement therapy with hemoperfusion in severe cases. 1, 2
Understanding Abrin Toxicity
- Abrin is a highly toxic protein found in the seeds of Abrus precatorius (jequirity beans), with an estimated human fatal dose of 0.1-1 microgram/kg 3
- At the cellular level, abrin inhibits protein synthesis, causing cell death and endothelial damage that leads to increased capillary permeability, fluid leakage, and tissue edema (vascular leak syndrome) 3
- Clinical manifestations primarily involve gastrointestinal toxicity when seeds are ingested 3
Initial Management
- For recent ingestions, consider gastric lavage and activated charcoal administration if the patient presents within 1 hour of ingestion 2, 4
- Do not administer anything by mouth for poisoning ingestions unless advised by poison control or emergency medical personnel 5
- Do not attempt to induce vomiting with syrup of ipecac as this is no longer recommended for toxin ingestions 5
- Contact poison control immediately (800-222-1222 in the US, 112 in Europe) for guidance on management 5
Supportive Care
- Administer intravenous fluids to correct dehydration from vomiting and diarrhea 1, 2
- Provide anti-emetics (such as ondansetron) to control vomiting 1
- Monitor and correct electrolyte imbalances 2
- Implement gastric acid suppression using proton pump inhibitors 2
- Provide liver protection and hemostasis measures as needed 2
Advanced Interventions for Severe Cases
- For severe poisoning with evidence of multi-organ involvement, consider continuous renal replacement therapy (CRRT) combined with hemoperfusion (HP) 2
- Monitor for signs of multi-organ failure, which is the primary cause of death in fatal cases 6
- There is no specific antidote for abrin poisoning 3, 4
Monitoring and Follow-up
- Monitor vital signs, mental status, and organ function (particularly renal and hepatic) 2
- Laboratory testing should include blood urea nitrogen, serum creatinine, liver function tests, and complete blood count 1
- Watch for symptoms of hematochezia and hematuria, which may indicate severe poisoning 2
- Observe for at least 24 hours even if symptoms appear to resolve 1
Important Considerations
- The severity of poisoning depends on how thoroughly the seeds were chewed and the amount of toxin per seed 4
- Onset of symptoms may be delayed, even in severe cases 6
- Confirmation of abrin exposure can be done through detection of L-abrine (N-methyl-L-tryptophan) as a biomarker in urine 1
- Patients may present with altered mental status ranging from somnolence to anxiety 2