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4th Pediatric Infectious Diseases Conference

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katiha...

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Drug

Treatment Details

Ricinus Communis (Arandi – Castor Oil Plant)

The castor plant grows all over India. Fruit is 1.2 to 2.5 cm. long, three-lobed, softly spiny, blue-green or rose-red when immature, brown and bristly when ripe and dry. Seeds are variable, smooth, flattened-oval, mottled, light and dark brown, or white with yellow-brown or gray markings, or wholly black and red. They are of two sizes, big and small. The small seeds are about 1.2 cm long and 0.8 cm broad, and resemble croton seeds. The whole plant is poisonous, although the seeds are the most poisonous, containing toxalbumin ricin, a water soluble glycoprotein {highest level in the seeds}, and a powerful allergen {CBA}. The seeds are rich in a purgative oil, which is pale yellow with a faint odour and acrid taste.
A toxalbumin or phytotoxin is a toxic protein which resembles a bacterial toxin in action, and causes agglutination of red cells with some haemolysis and is antigenic. The ‘press cake’ contains ricin and is poisonous, whereas castor oil contains ricinoleic acid, and is not poisonous as it does not contain ricin. Phytotoxin is a toxin produced by a plant. Ricin, crotin and abrin are phytotoxins. Animal toxalbumins are snake and scorpion venoms.
Ricin is excreted by intestinal epithelium. The unbroken seeds are non-poisonous when swallowed and also when cooked.

Route : Ingestion

Fatal dose : 5-10 seeds (crushed) / 6 mg. of ricin

Fatal Period : two to several days

Mechanism of action : Ricin blocks protein synthesis through the inhibition of RNA polymerase. Ricin has a special binding effect that allows it to gain access to the endoplasmic reticulum in the gastrointestinal mucosal cells causing severe diarrhoea

Clinical picture : Dust of the seeds may cause watering of the eyes, conjunctivitis, sneezing, acute nasal inflammation, headache, pharyngitis, asthmatic bronchitis, dermatitis and gastric upset.
Symptoms include burning in mouth, throat and stomach. Burning of the oral mucosa appears similar to an alkali burn. Salivation, nausea, vomiting, bloody diarrhoea, severe abdominal pain, thirst, impaired sight, weak rapid pulse, cramps in calves and abdominal muscles, haemolysis, drowsiness, delirium, convulsions, shallow breathing, uraemia, jaundice, dehydration, collapse and death. Ricin is excreted by the intestinal epithelium.

Treatment : Gastric lavage, activated charcoal, demulcents, symptomatic treatment.

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Should teicoplannin, colistin be used in case of neonatal sepsis where culture does not reveal any organism_?

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