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:

Page last reviewed: April 4, 2018