Abstract

A 30-year-old woman presented to the emergency department 2 days after ingestion of 50 castor beans. Her symptoms on admission were vomiting, diarrhea, abdominal cramps, agitation and anxiety. Initial laboratory tests showed a slightly elevated C-reactive protein and mild liver and kidney dysfunction. The patient was transferred to the medium care unit of our hospital where she was observed for possible organ failure. During the next days, the kidney function improved and liver function started to recover. Four days after admission, the patient was transferred to the psychiatric ward. Urine, serum, plasma and whole-blood samples were analyzed for ricinine using a quantitative LC–MS-MS method. Initial values on admission (serum and urine) were very high in comparison with previously reported cases. Based on these values, the patient was monitored closely in the following days. The patient made a full recovery, and during the course of hospitalization, concentrations of ricinine in plasma/serum, blood and urine gradually declined. The presence of ricinine in a patient’s blood or plasma is a proof of castor bean and, hence, ricin exposure. However, based on this case and previously reported cases in literature, we can conclude that no clear correlation can be established between ricinine blood, plasma or urine levels and the severity of the intoxication. Clinicians should be aware of the potential danger of a ricin intoxication, and patients should be monitored closely for several days due to the unpredictable outcome of the intoxication.

中文翻译：

---

摄入 50 粒蓖麻子引起的非致命中毒：连续测量血液、血浆和尿液中的蓖麻碱

 抽象的

一名 30 岁的女性在摄入 50 颗蓖麻子两天后被送往急诊室。她入院时的症状包括呕吐、腹泻、腹部绞痛、烦躁和焦虑。初步实验室检查显示 C 反应蛋白轻度升高，肝肾功能轻度障碍。该患者被转移到我们医院的中度监护病房，在那里观察她是否可能出现器官衰竭。接下来的几天里，肾功能得到改善，肝功能开始恢复。入院四天后，患者被转到精神科病房。使用定量 LC-MS-MS 方法分析尿液、血清、血浆和全血样品中的蓖麻碱。与之前报告的病例相比，入院时的初始值（血清和尿液）非常高。根据这些值，在接下来的几天里对患者进行了密切监测。患者完全康复，住院期间血浆/血清、血液和尿液中蓖麻碱浓度逐渐下降。患者血液或血浆中存在蓖麻碱是蓖麻子存在的证据，因此也是蓖麻毒素暴露的证据。然而，根据该病例以及文献中先前报道的病例，我们可以得出结论，蓖麻碱血液、血浆或尿液水平与中毒严重程度之间没有明确的相关性。临床医生应意识到蓖麻毒素中毒的潜在危险，并且由于中毒结果不可预测，应密切监测患者数天。