Ricin: Treatment Overview for Clinicians

General Information

• 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.

Treatment Recommendations

• 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.
  • Inhalation
    • 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.
  • Ingestion
    • 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