Ricin: Treatment Overview for Clinicians
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- Maintain high suspicion for ricin poisoning.
- Get ricin off or out of the body as quickly as possible, there is no antidote.
- Treatment consists of supportive measures.
- If an incident (e.g., ricin exposure) affects a large population and large quantities of pharmaceuticals and/or medical supplies are required, these may be provided through the Strategic National Stockpile.
- Transfer immediately to health care facility for additional medical attention.
- Incident Site Emergency Treatment
- Get fresh air by leaving the area of ricin release.
- If outside, move away from the area where the ricin was released, if indoors, get out of the building.
- Provide supportive treatment to minimize the effects of ricin poisoning, based on exposure and symptom factors.
- Place in half-upright position.
- Perform pulmonary toilet, if needed.
- Provide oxygen, and/or mechanical ventilation with positive end expiratory pressure to maintain oxygenation, if needed.
- Perform cardiopulmonary resuscitation if necessary.
- Do not induce vomiting.
- Administer a single dose of activated charcoal as soon as possible if the patient has suspected/known ricin ingestion, if vomiting has not begun and airway is secure.
- Do not give anything by mouth.
- Gastric lavage may be considered if ingestion has occurred in ≤1 hour.
- If vomiting, lean victim forward or place on left side, head-down position, if possible, to maintain open airway and prevent aspiration.
- Provide early and aggressive intravenous fluid and electrolyte replacement.
- Administer blood pressure support through the use of intravenous vasopressors, if needed.
- Ocular Exposure
- Flush eyes with large amounts of tepid water for at least 15 minutes.
- Dermal Exposure
- Remove clothing
- Decontaminate skin by showering or washing, using soap and water, and rinsing skin with plenty of water.
- Systemic Symptoms
- Give medication for control of seizure activity, if necessary.
- Administer medication for treatment of hypotension, if necessary.
- Healthcare Facility Emergency Treatment
- Provide supportive medical care.
- Follow Incident Site Emergency Treatment guidance.
- Contact regional poison control center, immediately upon suspicion of a case of ricin exposure, for guidance and further individualized management.
- Perform skin decontamination in a designated area outside the emergency department if ricin powder or similar substance is found on the patient and when there is known dermal exposure to ricin.
For additional information:
- Emergency Response Card: Ricin
- MMWR: Investigation of a Ricin-Containing Envelope at a Postal Facility --- South Carolina, 2003
- Facts About Ricin
- Recognition, Management and Surveillance of Ricin-Associated Illness
- Emergency Room Procedures in Chemical Hazard Emergencies: A Job Aid
- Strategic National Stockpile: Transport
- COCA Conference Call Summaries and Slides: Ricin As a Biological Agent
- Page last reviewed April 17, 2013
- Page last updated April 17, 2006
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