Ricin is a potent cytotoxin derived from castor bean mash. Over a million tons of mash are processed each year into industrial fluids. Traditionally, toxicity occurs following the ingestion of masticated castor beans. Hemorrhagic gastroenteritis, vascular collapse, and multisystem organ failure result from inhibition of protein synthesis. Following exposure to aerosolized ricin, airway necrosis is seen. Fever, chest tightness, cough, dyspnea, arthralgias, and profuse sweating begin within 4 to 8 h. Over the next 2 to 3 days, severe lung inflammation manifests as a progressive cough and hemorrhagic pulmonary edema. The diagnosis is difficult but may be confirmed by ELISA testing of serum or tissue. Treatment is supportive. If ricin is ingested, aggressive gut decontamination including the administration of activated charcoal may be considered.
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