Lopez Nunez Oscar F, Pizon Anthony F, Tamama Kenichi
Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Clinical Laboratories, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania.
Division of Medical Toxicology, Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
J Emerg Med. 2017 Nov;53(5):e67-e71. doi: 10.1016/j.jemermed.2017.08.023. Epub 2017 Oct 4.
Ricin is a protein toxin derived from the castor bean plant Ricinus communis. Several cases secondary to its consumption have been published and, more recently, its use as a potential bioterrorism agent has also been reported. Oral absorption of ricin is highly erratic, leading to a wide spectrum of symptoms. In addition, conventional urine drug screening tests will not be able to detect this compound, posing a diagnostic challenge.
A male teenager intended to die by ingesting 200 castor beans after mixing and blending them with juice. Eight hours later, he presented with weakness, light-headedness, nausea, and vomiting and sought medical treatment. The patient was admitted and treated conservatively. An immune-based standard urine toxicology drug screen panel was reported as negative. A comprehensive untargeted urine drug screen test showed the presence of ricinine, a surrogate marker of ricin intoxication. He was transferred to the psychiatric service 3 days after admission. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the importance of knowing the peculiar pharmacokinetic properties of ricin after oral ingestion of castor beans and toxin release through mastication. Emergency physicians should be aware that oral absorption of ricin is dependent on several factors, such type and size of seeds and the geographic harvesting region, making it extremely difficult to estimate its lethality based solely on the number of ingested beans. Finally, comprehensive untargeted urine drug screening testing is highly valuable as a diagnostic tool in this context.
蓖麻毒素是一种从蓖麻植物蓖麻中提取的蛋白质毒素。已有数起因摄入蓖麻毒素而引发的病例报道，最近，其作为一种潜在生物恐怖主义制剂的用途也被提及。蓖麻毒素的口服吸收极不稳定，会导致一系列广泛的症状。此外，传统的尿液药物筛查测试无法检测到这种化合物，这给诊断带来了挑战。
一名青少年男性将200颗蓖麻籽与果汁混合后打算服下自杀。8小时后，他出现乏力、头晕、恶心和呕吐症状并寻求治疗。患者入院后接受了保守治疗。基于免疫的标准尿液毒理学药物筛查结果为阴性。一项全面的非靶向尿液药物筛查测试显示存在蓖麻碱，这是蓖麻毒素中毒的替代标志物。入院3天后他被转至精神科。
急诊医生为何应了解此事？：该病例凸显了了解口服蓖麻籽后蓖麻毒素特殊药代动力学特性以及通过咀嚼释放毒素的重要性。急诊医生应意识到，蓖麻毒素的口服吸收取决于多种因素，如种子的类型和大小以及地理收获区域，这使得仅根据摄入的蓖麻籽数量来估计其致死性极为困难。最后，在这种情况下，全面的非靶向尿液药物筛查测试作为一种诊断工具具有很高的价值。
