II. Historical
- Used in assassination of Bulgarian exile Georgi Markov
- Gun disguised as Umbrella London 1978
- Implanted ricin pellet in his body
III. Pathophysiology
- Mechanism
- Ricin is a Protein toxin used as Biological Weapon
- Derived from castor plant (Ricinus communis)
- Small particle aerosol
- Transmission
- No secondary aerosol risk to healthcare workers
IV. Symptoms
- Weakness
- Fever
- Cough
- Dyspnea
- Chest tightness
- Arthralgia
- Gastrointestinal symptoms if ingested
V. Signs
- Pulmonary Edema
- Hypotension
- Vascular collapse
- Shock
- Disseminated Intravascular Coagulation (DIC)
- Multiple organ failure
VI. Radiology: Chest XRay
- Bilateral infiltrates on Chest Radiographs
- Pulmonary Edema
VII. Labs
VIII. Differential Diagnosis
IX. Course
- Pathologic changes seen as early as 8 hours
- Symptom onset 18-24 hours after inhalation
- Severe respiratory distress and failure in 36-72 hours
X. Management
- Supportive for Pulmonary Edema
- Gastric Decontamination for ingestion
XI. Prevention
- No Vaccine or antitoxin available