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.