Poison Control Center, University of Kansas Hospital , Kansas city, KS , USA.
Clin Toxicol (Phila). 2014 Apr;52(4):265-8. doi: 10.3109/15563650.2014.892124. Epub 2014 Mar 2.
Ingestions of the seed of the castor bean plant (Ricinus communis) carries the risk of toxicity from ricin, a potent inhibitor of protein synthesis.
We sought to describe characteristics of castor bean seed exposures reported to a state-wide poison control system.
This was an observational case series. A state-wide poison control system's database was reviewed for exposures to castor bean plant seeds from 2001 to 2011. Case notes were reviewed and data collected, when available, included age, gender, circumstances surrounding exposure, number of castor beans consumed, whether beans were chewed or crushed, symptoms described, laboratory values (aspartate aminotransferase [AST], alanine aminotransferase [ALT], prothrombin time [PT] and international normalized ratio [INR]), duration of follow-up, treatment, and patient outcomes.
Eighty-four cases were identified. Ingestions were unintentional in 50 cases (59%) cases and intentional in 34 (40%) cases. A median of 10 seeds (range: 1-20) were ingested in intentional cases versus 1 seed (range: 1-40) in unintentional cases. In 49 (58%) of cases the seeds were reported to have been chewed or crushed. Gastrointestinal symptoms were the most commonly reported symptoms. Vomiting (n = 39), nausea (n = 24), diarrhea (n = 17), and abdominal pain (n = 16) predominated. One patient developed hematochezia and vomiting after reportedly ingesting and intravenously injecting castor bean seeds. Laboratory values were documented in 17 (20%) cases. Only one abnormality was noted; an asymptomatic patient one week following ingestion had AST/ALT of 93 U/L and 164 U/L, respectively. Ricinine was confirmed in the urine of two patients. Twenty-three (27%) cases received activated charcoal. Seventy-two (86%) of cases were calls from health care facilities or referred to health care facilities by the poison control center. Twenty-two (26%) cases were admitted for a median of 2 days (range: 1-10). Admitted cases ingested a median of 8.5 seeds (range: 1-20). Intentional ingestions were followed for median of 37.5 h (range: 0.5-285.5) while unintentional cases were followed for 14 h (range: 1-182). No delayed symptoms, serious outcomes, or deaths were reported.
Due to the presence of ricin, there is concern for serious outcomes after ingestions of the seeds of the castor bean plant. In this study GI symptoms were most commonly reported but serious morbidity or mortality was not present. The true risk of castor bean plant seed ingestions should continue to be re-evaluated.
In this retrospective review, gastrointestinal symptoms were the most common symptoms described after reported exposures to castor bean seeds. These exposures were not associated with serious morbidity, mortality, or delayed symptoms.
摄入蓖麻子（Ricinus communis）的种子有蓖麻毒素中毒的风险，蓖麻毒素是一种有效的蛋白质合成抑制剂。
我们旨在描述向全州毒控系统报告的蓖麻子种子暴露的特征。
这是一项观察性病例系列研究。回顾了 2001 年至 2011 年全州毒控系统数据库中蓖麻子植物种子暴露的病例。审查了病例记录，并收集了可用的数据，包括年龄、性别、暴露环境、摄入的蓖麻子数量、种子是否咀嚼或压碎、描述的症状、实验室值（天冬氨酸氨基转移酶[AST]、丙氨酸氨基转移酶[ALT]、凝血酶原时间[PT]和国际标准化比值[INR]）、随访时间、治疗和患者结局。
确定了 84 例病例。50 例（59%）为非故意摄入，34 例（40%）为故意摄入。在故意摄入的病例中，中位数摄入 10 粒（范围：1-20 粒）种子，而非故意摄入的病例中中位数摄入 1 粒（范围：1-40 粒）种子。49 例（58%）报告种子被咀嚼或压碎。胃肠道症状是最常见的报告症状。呕吐（n=39）、恶心（n=24）、腹泻（n=17）和腹痛（n=16）为主。1 例患者在摄入并静脉注射蓖麻子种子后出现血便和呕吐。17 例（20%）病例记录了实验室值。仅发现 1 例异常；1 例无症状患者在摄入后 1 周时的 AST/ALT 分别为 93 U/L 和 164 U/L。两名患者的尿液中检测到蓖麻毒素。23 例（27%）患者接受了活性炭治疗。72 例（86%）为医疗机构电话或毒控中心转介的病例。22 例（26%）患者因摄入中位数 8.5 粒（范围：1-20 粒）种子而住院，中位数住院 2 天（范围：1-10 天）。故意摄入者的随访时间中位数为 37.5 小时（范围：0.5-285.5），而非故意摄入者的随访时间中位数为 14 小时（范围：1-182 小时）。未报告迟发性症状、严重结局或死亡。
由于蓖麻毒素的存在，摄入蓖麻子植物种子后存在严重后果的担忧。在这项研究中，胃肠道症状是最常见的报告症状，但没有出现严重的发病率或死亡率。蓖麻子植物种子摄入的真实风险应继续重新评估。
在这项回顾性研究中，胃肠道症状是报告的蓖麻子种子暴露后最常见的症状。这些暴露与严重的发病率、死亡率或迟发性症状无关。
