Ricin

Notice

Date: 9 January 2003 Reference: CEM/CMO/2003/2

Title: INTERIM GUIDELINES FOR HEALTH PROFESSIONALS ON THE RESPONSE TO SUSPECTED RICIN EXPOSURE

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Clinical situations may arise in which ricin exposure may need to be considered.

  • Guidelines on actions to be taken in the event of a deliberate release of ricin are already available on the PHLS website.
  • Guidance on suspect packages and materials and on the investigation of unknown illness are also available at the same site. The document on outbreaks and incidents of unusual illness contains specific advice on:
    • Whether an incident may have been caused by a deliberate release (page 34 - checklist 2)
    • Actions to be taken by specific groups dealing with cases of unusual illness: hospital clinicians (page 26 -flowchart 4); general practitioners (page 48; ambulance services (page 18); pathologists (page 53); local laboratories (page 58); and public health professionals (page 67)
    • Initial classification of possible aetiology of unusual illness (page 12 - flowchart 2)
    • Management of outbreak/ incident according to likely aetiology (page 69); and
    • Sources of expert advice (page 81)
  • It is important to take expert advice early from:
    • National Poisons Information Service
    • Regional Service Provider Units
    • PHLS
    • Consultants in Communicable Disease Control
  • It is important to inform early:
    • Local Gardai
    • Consultants in Communicable Disease Control
    • GPs and Ambulance Service

Joint statement from deputy chief medical officer 7 January 2003

Ricin

Is a protein toxin that is derived from castor oil seeds. It inhibits protein synthesis and has widespread toxic effects on the body. These include damage to most organ systems and a combination of pulmonary, liver, renal and immunological failure may lead to death. No antidote is known: treatment can only be supportive.

Clinical features of ricin:

  • The early symptoms depend on the route of exposure.
  • Fever, gastrointestinal upset, coughing may be amongst the first effects noted.
  • Absorption via the lung as a result of exposure to aerosolised toxin leads to particularly serious lung damage including pulmonary ooedema and Adult Respiratory Distress Syndrome.
  • Ingestion of ricin causes irritation of the gut: gastroenteritis, bloody diarrhoea and vomiting.
  • Effects on the Central Nervous System have been reported including seizures and CNS depression.

The effects of exposure to ricin may be delayed for some hours after exposure and patients who develop a fever may consult their own doctors.

A full range of guidance on ricin and other chemical and biological agents on the PHLS website.

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