Bioterrorism: Ricin Attack and Pregnancy [4M]

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Abstract

INTRODUCTION:

Chemical agents have been used as weapons for centuries. Ricin is derived from the castor bean and its toxic effects have been documented. It has been used in at least twelve attacks the past decade. Pregnant women may come in contact with ricin in the future and guidelines for diagnosis and treatment are necessary.

METHODS:

All available information of ricin effects on maternal and fetal physiology was searched.

RESULTS:

While ingestion is the most likely etiology, widespread inhalation ricin exposure via a bioterror attack is the most worrisome. Symptoms of nausea, vomiting, and abdominal pain are easily misdiagnosed with ricin, but develop rapidly in 4–6 hours, and progress over the next 12–24 hours to develop severe dehydration, and kidney and liver damage. Death may result in 36–72 hours. Treatment in pregnancy is similar to of non-pregnant adults, and include respiratory support, intravenous access, seizure precautions, extensive washing, and gastric flushing with activated charcoal (if GI exposure).

CONCLUSION:

Pregnant women are listed by the CDC as a vulnerable population who may be at higher risk of severe injury with exposure to ricin. Thus, in the event of an intentional attack, it is recommended that obstetricians: 1. Urge patients to seek immediate medical evaluation, as symptoms start early and progress rapidly. 2. After 24 hours, it is unlikely that symptoms will develop and patients can be discharged with symptomatic follow-up. 3. Enhanced fetal monitoring and counselling should be scheduled to discuss the long term risks of a teratogenic syndrome similar to fetal hydantoin syndrome.

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