Using Forensic Nursing Skills to Diagnose Ricin Poisoning

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Ricin is a poison that can be made from the waste left over from processing castor beans. It can be in the form of a powder, a mist, or a pellet, or it can be dissolved in water or weak acid. It is a stable substance. Ricin is not contagious. Exposure happens through inhalation, ingestion, or skin or eye exposure.

Ricin is found as castor beans are processed throughout the world to make castor oil. Ricin is part of the waste “mash” produced when castor oil is made. Ricin works by getting inside the cells of a person’s body and prevents the cells from making the proteins they need. Eventually this is harmful to the whole body, and death may occur. It has some potential medical uses, such as bone marrow transplants and cancer treatment (to kill cancer cells).

Symptoms typically occur in less than 6 hours after ingestion of ricin. The effects of ricin poisoning depend on whether ricin is inhaled, ingested or injected. Ricin also depends on the dose received. Ricin is very toxic.

Death from ricin poisoning could take place within 36 to 72 hours of exposure. Inhalation causes initial symptoms to occur within 8 hours of exposure. Those symptoms are respiratory distress, fever, cough, nausea, tightness in the chest and heavy sweating. Ingestion causes vomiting, bloody diarrhea, severe dehydration, hallucinations, seizures, and blood in the urine. Within several days, multisystem organ failure may occur. Skin and eye exposure from ricin powder or mist form can cause redness and pain of the skin and the eyes.

Diagnosis is by clinical evaluation. In more complex cases where pulmonary edema is a concern, a chest x-ray may be obtained.

Currently, there is no antidote for ricin. Supportive care should be given. If exposure cannot be avoided, the most important factor is then getting the ricin off or out of the body as quickly as possible.

As a forensic nurse, it is important to realize that these poisonings are possible. Although there are not common, ricin poisoning needs to be considered in the differential diagnosis as the outcome could be fatal if misdiagnosed.

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