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Emergency Response Card (CDC/NIOSH) - Ricin - ERC9009-86-3
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NIOSH EMERGENCY RESPONSE CARD
BIOTOXIN
RICIN
UN #: 3172 GUIDE 153
Ricine
Ricinus lectin
Ricinus agglutinin
Ricinus toxin
Lectin isolated from seeds of the castor bean
(Ricinus communis) protein/polypeptide
CAS #: 9009-86-3
Alternate CAS #: 9067-26-9
RTECS #: VJ2625000
Chemical Formula: N/A
Molecular mass: N/A
TYPES OF
HAZARD/
EXPOSURE
ACUTE HAZARDS/
CLINICAL SIGNS/
SYMPTOMS
PREVENTION/
PERSONAL
PROTECTIVE
EQUIPMENT
FIRST AID/
FIRE FIGHTING
FIRE
N/A
Avoid generating dust.
Foam, dry chemical powder, BCF
(where regulations permit), carbon
dioxide, water spray or fog - large
fires only.
EXPLOSION
N/A
N/A
N/A
Extremely Toxic. May be Fatal.
AVOID ALL CONTACT.
Ricin (and Abrin) cause toxicity by
inhibition of protein synthesis.
Seek medical attention
immediately.
STRICT HYGIENE!
May adhere to skin or
clothing.
ROUTE OF
EXPOSURE
Synopsis:
May cause severe allergic reactions.
Inhalation:
May cause severe lung damage and death
in humans (based on reports of exposure
in animals). Symptoms may include fever,
cough, and pulmonary edema within 18-24
hours and respiratory distress and death
within 36-72 hours. Repeated exposure in
humans might lead to allergic/asthma-like
symptoms including congestion of the
nose and throat, itchiness of the eyes,
hives, tightness of the chest, and in severe
cases, wheezing.
Pressure demand, selfcontained breathing
apparatus (SCBA) (SCBA
CBRN, if available) is
recommended in response
to non-routine emergency
situations.
Fresh air, rest. Half-upright position. If
breathing is difficult, administer
oxygen. Perform CPR if necessary.
Seek medical attention immediately.
In other situations, two types
of full facepiece, tight-fitting
masks may be used: 1)
Powered Air Purifying
respirator (PAPR) with
HEPA filters; or 2) Air
Purifying respirator (APR)
with P100 filters.
See CDC/NIOSH Interim
Recommendations for
guidance on selection
criteria.
Skin:
Risk of dermal toxicity is low. May be
absorbed through irritated, damaged, or
injured skin or through normal skin if aided
by solvent carrier. Potential for allergic skin
reaction; redness, blisters, pain.
Tychem® BR or
Remove contaminated clothes. Rinse
Responder® CSM protective skin with plenty of water or shower
clothing. Eyes should be
(and soap if available).
protected when possible.
Seek medical attention immediately.
Eyes:
Tearing, swelling of the eye-lids, pain,
redness, corneal injury. Systemic toxicity
and lethality reported in animals with
Full face-piece respirator
provides eye protection.
http://www.bt.cdc.gov/agent/ricin/erc9009-86-3pr.asp
Immediately flush with large amounts
of tepid water for at least 15 minutes.
4/11/2007
Emergency Response Card (CDC/NIOSH) - Ricin - ERC9009-86-3
isolated ocular exposures.
Ingestion:
Symptoms are rapid in onset (generally
less than a few hours) following ingestion.
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Seek medical attention immediately.
Do not eat, drink, or smoke
during work. Wash hands
before eating.
Nausea, vomiting, abdominal pain and
cramping.
Diarrhea
Gastrointestinal Bleeding
Low or no urinary output
Fever
Thirst
Sore Throat
Headache
Vascular collapse and shock
OCCUPATIONAL
EXPOSURE LIMITS (OELs)
OSHA PEL: N/A
NIOSH REL: N/A
ACGIH TLV: N/A
ChemWatch: Ceiling: 0.00006 (sensitizer) mg/m3
NIOSH IDLH: N/A
SAMPLING AND
ANALYTICAL METHODS
NIOSH: N/A
May be fatal. However, the death rate
even among symptomatic patients is
generally low. Do not induce
vomiting. Rinse mouth. Use slurry of
activated charcoal. If individual is
drowsy or unconscious, do not give
anything by mouth. In the event of
vomiting, lean patient forward or
place on left side (head-down
position, if possible) to maintain open
airway and prevent aspiration. Early
and aggressive IV fluid and
electrolyte replacement.
Seek medical attention immediately.
OSHA: N/A
Contact Laboratory Response Network Lab for sampling information
(see http://www.bt.cdc.gov/agent/ricin/labtesting.asp)
DECONTAMINATION
Limited data available regarding decontamination approaches.
Patient/Victim: Wash with soap and water. Work clothes should be laundered separately. Launder contaminated
clothing before re-use. Do not take clothing home.
Equipment: If not disposable, personal protective equipment such as gloves, faceshields, and goggles should be
decontaminated by thoroughly rinsing with soap and water, and then rinsing with water and allowing to air dry.
Environment: Check with EPA for any new cleanup developments. Surfaces can be cleaned with 0.1% or 0.5%
solution of sodium hypochlorite (0.1% =1 part household bleach to 49 parts of water; 0.5%= 1 part household
bleach to 9 parts of water). No guidelines for contact time are available so post-cleaning surface sampling is
recommended to check on effectiveness. Steam cleaning with a 0.1N solution of sodium hydroxide has been
used for carpets. HEPA vacuums can be used as part of a clean up approach but other methods that can
generate dust should be avoided.
NOTE: The use of proper personal protective equipment (PPE) is recommended for all workers exposed to dilute
bleach and/or sodium hydroxide solutions used for decontamination. Cleanup workers are advised to wear
respiratory protection (full-face respirator with combination acid gas/particulate filter for chlorine bleach, or
particulate filter for sodium hydroxide) and gloves (butyl rubber, neoprene, nitrile, or polyethylene) as safeguards
against chemical burns to the skin and airways.
SPILLAGE DISPOSAL
Polyethylene or polypropylene container.
Keep containers securely sealed when not in use.
Store in a cool, dry, well-ventilated area and away from food stuff containers.
PACKAGING &
LABELLING
UN#: 3172 (GUIDE 153)
Proper Shipping Name: N/A
Hazard Class: 6.1(a)
Packing Group: I
NFPA 704 Signal:
Health - N/A
Flammability - N/A
Reactivity - N/A
http://www.bt.cdc.gov/agent/ricin/erc9009-86-3pr.asp
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Emergency Response Card (CDC/NIOSH) - Ricin - ERC9009-86-3
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Special - N/A
IMPORTANT DATA
PHYSICAL STATE; APPEARANCE:
White powder. NOTE that powder may be put into solution.
PHYSICAL DANGERS:
Product is considered stable. Avoid contact with oxidizing agents.
CHEMICAL DANGERS:
Hazardous polymerization will not occur.
ROUTES OF EXPOSURE:
Can be absorbed by all routes of exposure.
INHALATION RISK:
Pulmonary edema and potential death, irritation, and sensitization.
EFFECTS OF SHORT-TERM EXPOSURE:
Severe vomiting and diarrhea may result in severe dehydration (hypovolemic-shock) and multisystem organ
failure: effects on GI tract, kidney, liver, and pancreas. Potentially fatal due to severe allergic reaction.
EFFECTS OF LONG-TERM OR REPEATED EXPOSURE:
Repeated inhalation exposures to sub-lethal levels may result in an allergic syndrome with congestion of nose
and throat; itchy, watery eyes; hives; tightness of the chest; and in severe cases - wheezing.
PHYSICAL
PROPERTIES
Melting Point: N/A
Boiling Point: decomposes (See Additional Information.)
Vapor Pressure (20°C): Negligible
Density (20°C): N/A
Volatility: Negligible
Specific gravity: N/A
Aqueous solubility(20°C): soluble
Soluble: 10% NaCl solution estimated log Kow: N/A
Flashpoint: N/A
Flammability: N/A
ENVIRONMENTAL
DATA
ACUTE EXPOSURE
GUIDELINES (AEGLs)
10 min 30 min 1hr 4 hr 8 hr
AEGL 1 (discomfort, non-disabling)
N/A
N/A
N/A N/A N/A
AEGL 2 (irreversible or other serious, long-lasting effects or impaired ability to
escape)
N/A
N/A
N/A N/A N/A
AEGL 3 (life-threatening effects or death)
N/A
N/A
N/A N/A N/A
NOTES
Reported lethal dose estimates are based on animal experiments and vary depending on the route of exposure. Inhaled doses of 3 - 5 mcg/kg are
lethal in mice; 20 - 40 mcg/kg have been shown to be lethal in nonhuman primates. Depending on species, oral exposures to ricin appear to be
less toxic than are other routes of exposure and a toxic exposure in humans may involve mg/kg concentrations.
ADDITIONAL
INFORMATION
Ricin is detoxified in 10 mins at 176°F (80°C) and in 1 hr at 122°F (50°C); it is stable under ambient conditions.
GLOSSARY OF
ACRONYMS
APR - Air-purifying Respirator
CBRN - Chemical, Biological, Radiological, Nuclear
IDLH - Immediately Dangerous to Life and Health
REL - Recommended Exposure Limit
PEL - Permissible Exposure Limit
SCBA - Self-Contained Breathing Apparatus
http://www.bt.cdc.gov/agent/ricin/erc9009-86-3pr.asp
4/11/2007
Emergency Response Card (CDC/NIOSH) - Ricin - ERC9009-86-3
IMPORTANT
NOTICE:
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RICIN (ERC9009-86-3) The user should verify compliance of the cards with the relevant STATE or TERRITORY
legislation before use. NIOSH, CDC 2003.
http://www.bt.cdc.gov/agent/ricin/erc9009-86-3pr.asp
4/11/2007
SUMMARY
Centers for Disease Control and Prevention
Clinician Outreach and Communication Activity
Clinician Briefing
Ricin as a Biologic Agent
January 27, 2004
Lieutenant Commander Joshua Schier, M.D.
United States Public Health Service
Medical Toxicologist
Health Studies Branch, National Center for Environmental Health
Centers for Disease Control and Prevention
**Please note: Data and analysis discussed in these presentations were current when presented. Data
collection and analysis are ongoing in many cases, therefore updates may be forthcoming elsewhere on this
website, through publications such as CDC's Morbidity and Mortality Weekly Report or other venues.
Presentations themselves will not be updated. Please bear this in mind when citing data from these
presentations
BACKGROUND
Ricin is a potent toxalbumin present in the castor bean plant, which grows in warm
climates throughout the world. Castor beans are a commercial source of castor oil which
is extracted from the castor bean and used for a number of different purposes. Castor oil
does not contain any ricin toxin.
Ricin exerts its toxicity by inhibiting protein synthesis in eukaryotic cells, which may
ultimately lead to cell death.
Ricin can be produced in three forms: liquid, crystalline, or dry powder. It is watersoluble, odorless, tasteless, and stable under ambient conditions.
Ricin exposure can occur through ingestion, inhalation, dermal or ocular contact, or
injection. Inhalation and parenteral exposure are the most lethal routes of administration.
Experience with ricin poisoning is very limited and is based on animal studies, one
homicide, three suicides, many cases of ingestion of macerated castor beans, and
occupational exposure to castor bean dust, pulp, and oil.
Ricin would need to be dispersed in particles smaller than five microns to be used as an
effective terrorist or military weapon by the inhalational route. It is very difficult to
prepare particles of this size. Ricin could also be used as a terrorist weapon through the
contamination of food, beverages, or potentially some consumer products.
CLINICAL PRESENTATION OF RICIN POISONING
Ingestion
The ingestion and mastication of three to six castor beans is the estimated fatal dose in adults.
The fatal dose in children is not known but is likely less.
Mild Toxicity Symptoms
Nausea, vomiting, diarrhea, and/or abdominal cramping.
Oropharyngeal irritation may also occur following ingestion.
Symptoms typically resolve within 24 hours, and bloody diarrhea and systemic signs,
such as hypotension, hemolysis, and renal failure, are not present.
The onset of gastrointestinal symptoms after ingestion typically occurs in less than ten
hours. Delayed presentation of gastrointestinal symptoms beyond ten hours of ingestion
is extremely unlikely.
Moderate to Severe Toxicity Symptoms
Moderate to severe poisoning may include gastrointestinal symptoms, such as persistent
vomiting and voluminous diarrhea – either bloody or non-bloody. The latter may lead to
significant fluid loss resulting in dehydration and hypovolemic shock, which would
manifest as tachycardia, hypotension, decreased urine output, and possibly altered mental
status, such as confusion or disorientation.
In severe poisoning, hepatic and renal failure – as well as death – are possible within 36
to 72 hours of exposure. The most common findings on animal autopsy are multifocal
ulcerations and hemorrhages of gastric and small intestinal mucosa, necrosis of
mesenteric lymph nodes, hepatic necrosis, splenitis, and nephritis.
Inhalational Exposure
Data on inhalational exposure to ricin in humans is extremely limited, and systemic
toxicity as a result of ricin inhalation has not been described in humans. Animal studies
suggest that inhalation is one of the most lethal forms of ricin poisoning.
Unintentional sublethal aerosol exposures to ricin occurred in humans in the 1940s and
were characterized by onset of the following symptoms within four to eight hours: fever,
chest tightness, cough, difficulty breathing, nausea, and arthralgias, followed by
diaphoresis. However, there was no reported progression of illness in these cases.
In a nonhuman primate study, inhalational toxicity was manifested by a dose-dependent,
preclinical period of eight to twenty-four hours followed by anorexia and decreased
activity. On autopsy, the lungs were edematous, with accompanying necrosis and
hemorrhage.
Inhalational exposure to ricin in animals may include the development of pulmonary
edema and hemorrhage, hypotension, respiratory failure, and death within 36 to 72 hours.
Summary, Conference Call, January 27, 2004
Clinician Outreach and Communication Activity
Ricin as a Biologic Agent
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Although there is no human data, humans can probably be expected to follow a similarly
rapid course of illness progression, although dose, size of the ricin particle, and duration
of exposure will affect degree of poisoning.
An allergic syndrome has been reported in workers exposed to castor bean dust in or
around castor oil processing plants. It is characterized by nasal and throat congestion,
eye irritation, hives and skin irritation, chest tightness, and in some severe cases,
wheezing.
Particles smaller than 5 microns have been used for aerosol dispersion in animal studies.
Ricin is not considered persistent in the environment, but particles of this size may stay
suspended in undisturbed air for many hours, and resuspension of settled ricin from
disturbed surfaces may occur.
Intravenous Exposure
Experience with human exposure by injection is limited to only a few cases some of which are
discussed below:
A 20-year-old man was admitted to the hospital 36 hours after injecting castor bean
extract subcutaneously. He complained of nausea, weakness, dizziness, and myalgias.
He developed anuria and hypotension, followed by hepatorenal and cardiorespiratory
failure, and died 18 hours following admission.
A 36-year-old chemist extracted ricin from a castor bean and self-administered
intramuscular injections for the purpose of scientific curiosity. He developed fever,
nausea, anorexia, mild elevation of liver function tests, and tissue damage at the site of
injection. Symptoms persisted for approximately eight to ten days and then improved, at
which point he was discharged from the hospital.
The Bulgarian dissident, Georgi Markov, is thought to have been assassinated with an
extremely small amount of ricin, however, the ricin was never actually confirmed. His
symptoms included immediate pain at the injection site, weakness within five hours, and
fever and vomiting within 24 hours. His clinical course worsened to include shock,
multiorgan failure, and death over the next three days.
Ricin, coupled to cancer cell-specific antibodies, was administered intravenously to
cancer patients in very low doses in one large clinical trial evaluating ricin as a
chemotherapeutic agent. Flu-like symptoms with fatigue and myalgias were common
reported side effects and only lasted a few days.
DIFFERENTIAL DIAGNOSIS
Route of exposure will affect clinical and differential diagnosis as early inhalational ricin
poisoning will have primarily respiratory signs and symptoms, whereas ingested ricin
will probably present early with gastrointestinal symptoms.
o Differential diagnosis of inhalational ricin poisoning: consider staphylococcal
enterotoxin B; exposure to pyrolysis byproducts of organoflourines such as Teflon
or Kevlar, nitrogen oxides, phosgene, influenza, anthrax, Q-fever, and pneumonic
plague. These are just some examples of other diagnoses to consider and not an
all-inclusive list.
Summary, Conference Call, January 27, 2004
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Clinician Outreach and Communication Activity
Ricin as a Biologic Agent
o Differential diagnosis of ricin poisoning by ingestion: consider enteric pathogens
such as salmonella or shigella, mushrooms, caustics, iron or other metals, arsenic,
colchicine. These are just some examples of other diagnoses to consider and not
an all-inclusive list.
The current, very limited body of knowledge suggests that significant ricin poisoning
through inhalation, ingestion, and parenteral exposure would consist of a relatively rapid,
progressive worsening of symptoms over approximately four to 36 hours.
Early ricin poisoning through ingestion may resemble a typical gastroenteritis or through
inhalation, a simple respiratory illness. This may make it initially very difficult to discern
true poisoning from other common and less virulent illnesses such as an upper respiratory
tract infection or gastroenteritis.
The confirmation of ricin poisoning requires clinical manifestations of illness with
laboratory detection of ricin in either biologic fluids or environmental samples from the
area where the patient was exposed.
There are currently no clinically validated assays for the detection of ricin in biologic
fluids readily available. Further clinical tests for ricinine, an alkaloidal component of the
castor bean plant, are being developed, but also have not been tested for clinical use. The
potential uses of these tests for either ricin or ricinine in human samples would primarily
be for purposes of confirming exposure or assessing the prevalence of exposure rather
than diagnostic use.
The Centers for Disease Control and Prevention and member public health laboratories in
the Laboratory Response Network are able to detect ricin in environmental samples.
However, testing will most likely not be immediately available to assist in clinical
decision making. Environmental testing may document the potential for exposure or
affirm the exposure circumstance.
There are no additional laboratory tests readily available to the physician, such as a cell
blood count, serum electrolyte panel, or radiograph, that are pathognomonic for ricin
poisoning. The presence of leukocytosis and/or abnormal liver and renal function tests
may suggest ricin-associated illness in the correct clinical context but are not very
specific.
Suspicion and clinical diagnosis of ricin poisoning should occur when clinically
compatible illness is present in conjunction with a highly suspected or known exposure, a
credible threat, or an applicable epidemiologic clue.
DECONTAMINATION
Gross Decontamination
Only limited data or experience exist regarding approaches to decontamination of victims
following a ricin release. Therefore, what follows is based largely on inference from limited
information and our best judgment, using a prudent public health approach. The primary goal is
to make the victim as clean as possible after life threatening issues have been addressed.
Summary, Conference Call, January 27, 2004
Clinician Outreach and Communication Activity
Ricin as a Biologic Agent
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In the event of a recognized release or exposure, patients suspected to be contaminated
with ricin should receive gross decontamination to the extent possible prior to arrival in
the emergency department.
Decontamination at the scene of the release is generally preferable unless the medical
condition of a victim dictates immediate transport to the hospital.
Gross decontamination consists of
o Cutting away or otherwise removing all suspected contaminated clothing,
including jewelry and watches
o Washing off any obvious contamination with soap and copious amounts of water.
o Showering with liquid soap and warm water is widely considered the most
effective and preferred method for removing remaining hazardous substances
from a victim’s skin.
o For the comfort of the victims and to improve cooperation, during
decontamination, water should be at a comfortable temperature if at all possible,
and attention should be given to privacy considerations and to security of personal
belongings. The procedure should be explained to the victim so that he or she can
understand what is occurring.
o There is no need to perform skin decontamination for patients exposed to ricin
through ingestion only.
Environmental surfaces or equipment, such as in the ambulance, can be cleaned with
soap and water or a 0.1% sodium hypochlorite solution.
Used clothing removed from the victim should be double bagged and labeled as
contaminated and then secured in a safe location until it can be safely disposed of.
Nondisposable personal protective equipment, such as gloves, face shields, and goggles,
should be decontaminated by thoroughly rinsing with soap and water, soaking in a 0.1%
sodium hypochlorite solution for 15 minutes, and then rinsing with water and allowing to
air dry.
Personal protective equipment for first responders, including those who are
decontaminating victims at the scene, is generally determined by the incident commander
based on a hazard assessment and site conditions, including the mechanism of dispersal
and whether or not dispersal is continuing.
Preventing droplets from contacting broken skin or mucosal membranes, for example, the
mouth or eyes, is important when decontaminating someone or cleaning up bodily fluids
that may contain toxin.
Airborne dispersal of ricin during decontamination is an unlikely hazard.
Healthcare personnel decontaminating victims who arrive at the hospital without having
been adequately decontaminated on scene should use personal protective equipment
consisting of a full chemical resistant suit with gloves, surgical mask, and eye/face
protection such as face shield and goggles.
After completing decontamination tasks, personnel should carefully remove all PPE and
shower.
Because victims should have received gross decontamination prior to arriving at the
hospital or at the hospital prior to entering the emergency department, the quantity of
Summary, Conference Call, January 27, 2004
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Clinician Outreach and Communication Activity
Ricin as a Biologic Agent
contaminant that health care workers treating these patients may encounter should be
dramatically less than what originally may have been deposited on them. Simply
removing contaminated clothing can reduce the contaminant associated with the victim
by up to 90%.
Precautions for Healthcare Workers Treating Victims Who Have Been Grossly
Decontaminated
Although the risk for exposure to ricin is likely to be very low after gross
decontamination, it is still prudent to follow standard precautions when coming into
contact with the patient or his or her personal effects.
Healthcare workers should follow standard precautions:
o Wear scrubs or preferably a disposable gown and a lab coat
o Wear disposable nitrile gloves
o Wear a surgical mask and safety glasses/goggles or face shield to prevent
inadvertently contaminating mucous membrane
o Follow good hand hygiene practices after caring for patients
TREATMENT
Treatment of ricin poisoning is supportive; there is no known antidote.
Ricin is not dialyzable.
Healthcare providers should continue to use standard precautions when caring for
patients with suspected or known ricin-associated illness. This includes care given after
skin decontamination and when dealing with patient belongings and secretions.
Treating Ricin Ingestion
Perform gastrointestinal decontamination.
Consider gastric lavage if presentation is early – generally less than one hour after
exposure – if the patient is not vomiting and if no general contraindications are present.
If ingested ricin was in the form of a powder, liquid, or similar substance, consider gastric
lavage with a nasogastric tube.
Administer a single dose of activated charcoal if the patient has not begun to vomit and if
the airway is secure.
Current medical literature suggests that ricin poisoning by the oral route significantly
contributes to gastrointestinal losses of fluid and hypotension. Hypotension will interrupt
normal profusion of tissues and cause further organ dysfunction. Therefore, intravenous
fluid administration and blood pressure support through the use of intravenous
vasopressor agents should be used to counter fluid loss and hypotension.
Treating Inhalation and Parenteral Exposure
Treatment is still mainly supportive in nature.
Inhalational and parenteral poisoning is of much greater severity than oral poisoning,
based mostly on animal data.
Summary, Conference Call, January 27, 2004
Clinician Outreach and Communication Activity
Ricin as a Biologic Agent
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Inhalational poisoning will most likely require earlier and greater respiratory support.
This may include supplemental oxygen, pulmonary toilet, and mechanical ventilation
with positive end expiratory pressure to maintain oxygenation if needed.
Parenteral poisoning should be treated in a similar fashion as needed.
Further care should be supportive in nature and may consist of procedures such as
hemodialysis for renal failure.
Individualized management guidelines should always be obtained by calling your
regional poison control center, at 1-800-222-1222, or consulting your local medical
toxicologist.
RECOGNIZING RICIN POISONING
Certain epidemiologic clues may suggest the covert release of a chemical agent or a
biological toxin such as ricin:
o an unusual increase in the number of patients seeking care for potential chemical
or biological toxin related illness;
o unexplained death among otherwise healthy or young people;
o detection of unexplained odors on presenting patients;
o clusters of illness in people who have common characteristics, such as drinking
water from the same source;
o rapid onset of symptoms after an exposure to a potentially contaminated source;
o unexplained death of plants, fish or animals;
o presence of a particular syndrome known to be associated with a chemical agent
or biological toxin.
Patients who have clinical findings consistent with ricin-associated poisoning and have a
highly suspected or known exposure to ricin or who present in the context of a credible
threat, should be decontaminated as needed, treated as described above and admitted to a
hospital for observation of illness progression.
Although most available evidence suggests a relatively rapid progression of symptoms in
significant toxicity approximately 4 to 36 hours following exposure, experience with ricin
poisoning is very limited. A subsequent period of observation cannot be definitively
specified.
Persons who have had an exposure to a highly suspected or known ricin-containing
compound and who are asymptomatic should also be observed for development of ricinassociated illness.
Exposures in asymptomatic patients may vary considerably, and the specific situation of
each patient will help determine ultimate disposition. For instance, a patient who was on
the opposite side of the room when a sealed container of ricin was discovered may not
reflect a true exposure. Regardless, any patient that is sent home after a complete
evaluation should be instructed to return to the hospital immediately for development of
any signs or symptoms consistent with ricin-associated illness.
If someone has clinical findings consistent with ricin poisoning in the context of an
epidemiologic clue suggestive of a possible chemical or biological toxin-associated
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Ricin as a Biologic Agent
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illness, but with no suspected or known ricin exposure, nor in conjunction with a credible
threat, disposition should be determined after the proper public health authorities have
been notified. This includes the regional poison control center, as well as local and state
health departments.
If there is no highly suspected or known exposure, no credible threat, and no applicable
epidemiological clue, then disposition is left to the clinician’s judgment.
REPORTING
The regional poison control center and the local and/or state public health agencies,
should be contacted in all cases of illness consistent with ricin poisoning in the presence
of one or more of the following:
o A suspected or known exposure to ricin
o A credible threat of a ricin release
o An applicable epidemiological clue suggesting a chemical or biological toxin
release
The following cases should be reported to local and state health agencies as well as the
regional poison control center:
o Suspected or known cases of ricin exposure
o Any case of ricin-associated illness
o Clinical illness consistent with ricin poisoning in conjunction with a credible
threat
o Clinical illness consistent with ricin poisoning in conjunction with an applicable
epidemiological clue
To contact your regional poison control center, dial the national toll-free hotline, 1-800222-1222, which connects the caller automatically to the closest poison center in the
United States.
Note: Please refer to the following for additional information:
Slides and text of the December 30, 2004, CDC Webcast/satellite broadcast entitled
Recognition, Management and Surveillance of Ricin-Associated Illness
http://www.phppo.cdc.gov/phtn/webcast/ricin/default.asp
Investigation of a Ricin-Containing Envelope at a Postal Facility --- South Carolina,
2003 MMWR November 21, 2003 / 52(46);1129-1131.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5246a5.htm
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Clinician Outreach and Communication Activity
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