背景:蓖麻毒素是一种源自蓖麻植物蓖麻的蛋白质毒素。已经发表了一些继发于其消费的案例,最近,它作为一种潜在的生物恐怖主义剂也有报道。蓖麻毒素的口服吸收非常不稳定,导致广泛的症状。此外,常规尿液药物筛选测试将无法检测到这种化合物,构成诊断挑战。
方法:一名男性青少年打算在与果汁混合后摄入200粒蓖麻豆而死亡。八个小时后,他表现出软弱,头脑清醒,恶心,呕吐和求医。患者入院并保守治疗。基于免疫的标准尿毒理学药物筛选小组报告为阴性。一项全面的非目标尿液药物筛查测试显示存在蓖麻碱,蓖麻毒素中毒的替代标记。入院后3天,他被转移到精神病院。为什么一个紧急医生应该意识到这一点?:这个案例强调了了解蓖麻毒素在口服摄入蓖麻毒素和通过咀嚼释放毒素后独特的药代动力学特性的重要性。急诊医生应该意识到蓖麻毒素的口服吸收取决于几个因素,这种类型和大小的种子和地理收获区域,这使得仅根据摄入的豆类数量来估计其杀伤力极其困难。最后,在这种情况下,全面的非目标尿液药物筛查测试作为诊断工具非常有价值。
BACKGROUND: 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.
METHODS: 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.