(Courtesy and special thanks to Dr Waleed Al Sukait)
A 27 yr old man with no previous medical illness, presented to ED with severe abdominal pain and diarrhea which is started as watery then bloody. History of constipation for the past 3 days for which he went to local herbal store and was given a laxatives beans, . After one hour of taking them the patient started to experience this abdominal pain and diarrhea.
On examination , he is rolling in bed from pain. His vitals signs as following
HR 89, BP 123/73, RR 16, Spo2 100% RA, blood sugar 7 mmol, T 37 .Abdominal exam as well other system examination are unremarkable
This is the beans he crushed and consumed
Q1: What is the name of this beans and the expected toxicity?
Q2 How you will manage this patient ?
Thanks a lot Dr. Suad for the continued education. It is very interesting.
Castor beans contain ricin, one of the most toxic substances known. It may cause an acute and potentially fatal gastroenteritis in addition to neurological and ophthalmological manifestations.
Read a case reported from Oman (Nizwa) in 2008. There is no database about its prevalence. Increasing the awareness of the population to the dangers of ricin would be a way to avoid the utilisation of castor seeds in traditional therapies.
There is no specific treatment and symptomatic management to reduce the load of the toxin needs to be initiated quickly and early when a case of poisoning is suspected so that serious complications will be avoided.
Mind the Beans Cont'
These are castor beans that comes from castor oil plant (Ricinus communis L), which is used sometimes in herbal shops as laxatives' beans. The beans are oblong and light brown, mottled with dark brown spots. The seed is only toxic if the outer shell is broken or chewed.
Ricin is contained in the bean pulp following the separation of the oil from the beans. No ricin is thought to remain in the oil, and it is inactivated during extraction if done under heated conditions.
Toxicity results from the inhibition of protein synthesis, but other mechanisms are noted including apoptosis pathways, direct cell membrane damage, alteration of membrane structure and function, and release of cytokine inflammatory mediators.
In addition to the GI manifestations of vomiting, diarrhea, and dehydration, ricin can cause cardiac, hematologic, hepatic, and renal toxicity. All contribute to death in humans and animals.
Despite the obvious toxicity of this compound, death probably can be prevented by early and aggressive fluid and electrolyte replacement after oral ingestion
Treatment is mainly supportive as no antidote available . However , ricin have the potential for use in bioterrorism and have been already used in several occasions. A vaccine is being developed in USA primarily for military use.
This patient was admitted and treated supportively and he recovered.
References :
Goldfrank's Toxicologic Emergencies 11th edition.
Management: A specific treatment strategy should emphasize identification of the specific herbal preparation used by the patient, concurrent medication, and medical illness. Because herbal preparation toxicity varies greatly depending on the preparation used, careful examination may be aided by knowledge of the herbal preparation. In most cases, supportive care and discontinuation of the herbal preparation(s) are sufficient. Some herbal toxicities require specific laboratory analysis (electrolytes and liver function tests).
1. Name: Cassia Senna (irritating cathartics)
2. Stimulant laxative herbs that promote Diarrhea, vomiting, nausea, abdominal cramps
3. Used for colonic evacuation
4. cause electrolyte disorders, dependence
5. Dieter’s teas that contain combinations of herbal laxatives, including senna and Cascara sagrada , may produce profound diarrhea, volume depletion, and hypokalemia. They are associated with cases of sudden death, presumably as a result of cardiac dysrhythmias. Despite FDA warnings of the dangers of these weight loss regimens, dieter’s teas remain available in retail stores that sell nutritional supplements and are easily accessible to adolescents.