title: A case of abrin toxin poisoning, confirmed via quantitation of L-abrine (N-methyl-L-tryptophan) biomarker.
abstract: BACKGROUND
  The seeds of Abrus precatorius contain the highly toxic plant protein abrin. There is no antidote for abrin poisoning. Management, largely supportive, may consist of administering intravenous fluids, anti-emetics, and activated charcoal depending on the time of exposure. We report the presentation of a single case of unintentional abrin poisoning confirmed by the quantitation of L-abrine biomarker.
  
  
  METHODS
  A previously healthy 22-month-old, 11.5-kg female presented to the hospital after ingesting approximately 20 rosary peas (A. precatorius) sold as a "peace bracelet". Her primary manifestations were episodes of forceful emesis that included food particles progressing to clear gastric fluid. The patient was tachycardic (HR = 134 bpm) but had brisk capillary refill and normal blood pressure (96/60 mmHg). Laboratory testing revealed elevated blood urea nitrogen (16 mg/dL) and serum creatinine (0.4 mg/dL). In the emergency department, the patient was resuscitated with 40 mL/kg normal saline via peripheral IV and received ondansetron (0.15 mg/kg IV) to control retching. The patient was discharged well 24 h after the ingestion.
  
  
  CONCLUSIONS
  This is the first case of human abrin toxin poisoning confirmed by the quantitation of L-abrine as a biomarker. Quantifying the levels of abrin toxin in the body after exposure can help clinicians make informed decisions when managing patients with symptomatic exposures to seeds of A. precatorius.
authors: National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA, jvw2@cdc.gov.
authors: Joe Valentine
authors: JV
authors: Wooten
authors: Christopher T
authors: CT
authors: Pittman
authors: Thomas A
authors: TA
authors: Blake
authors: Jerry D
authors: JD
authors: Thomas
authors: John J
authors: JJ
authors: Devlin
authors: Renee A
authors: RA
authors: Higgerson
authors: Rudolph C
authors: RC
authors: Johnson
mesh_terms: D000036:Abrin / Q000506:poisoning*; D015415:Biomarkers; D005260:Female; D006801:Humans; D026121:Indole Alkaloids / Q000032:analysis*; D007223:Infant
chemical_list: D015415:Biomarkers; D026121:Indole Alkaloids; D000036:Abrin; C496492:abrine