title: Early plasma exchange for treating ricin toxicity in children after castor bean ingestion.
abstract: Plasma exchange (PE) for the treatment of ricin toxicity has not been previously reported. Here we describe the use of PE to treat children who experienced ricin toxicity after ingesting castor beans. Seven children (median age: 8.1 years) who consumed castor beans (median: 5 beans) were treated with PE. All had bradycardia and sinus arrhythmia, and most had experienced episodes of vomiting and/or diarrhea. PE settings were blood flow, 50-80 mL/min; PE rate, 600-800 mL/h; volume of exchange, 1440-1950 mL. Median time from ingestion to PE was 73 h. All clinical symptoms disappeared and vital signs rapidly returned to normal after PE; no severe organ dysfunction occurred. All children were discharged and recovered uneventfully. Concentrations of all serum biochemical parameters significantly decreased immediately after PE. Some, but not all, of these parameters were also significantly decreased at 48 and 72 h after PE compared with before PE. Our findings suggest that PE can be an effective early intervention in the treatment of ricin toxicity due to castor bean ingestion.
authors.affiliation: Department of Pediatrics, Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, 350025, China.|Department of Pediatrics, Clinical Medical College of Fujian Medical University in Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, China.|Department of Pediatrics, Dongfang Hospital, Affiliated to Xiamen University, Fuzhou, 350025, China.
authors.forename: Cheng-feng
authors.initials: CF
authors.lastname: Wang
authors.affiliation: Department of Pediatrics, Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, 350025, China.|Department of Pediatrics, Clinical Medical College of Fujian Medical University in Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, China.|Department of Pediatrics, Dongfang Hospital, Affiliated to Xiamen University, Fuzhou, 350025, China.
authors.forename: Xiao-jing
authors.initials: XJ
authors.lastname: Nie
authors.affiliation: Department of Pediatrics, Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, 350025, China.|Department of Pediatrics, Clinical Medical College of Fujian Medical University in Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, China.|Department of Pediatrics, Dongfang Hospital, Affiliated to Xiamen University, Fuzhou, 350025, China.
authors.forename: Guang-ming
authors.initials: GM
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, 350025, China.|Department of Pediatrics, Clinical Medical College of Fujian Medical University in Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, China.|Department of Pediatrics, Dongfang Hospital, Affiliated to Xiamen University, Fuzhou, 350025, China.
authors.forename: Zi-hua
authors.initials: ZH
authors.lastname: Yu
authors.affiliation: Department of Pediatrics, Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, 350025, China.|Department of Pediatrics, Clinical Medical College of Fujian Medical University in Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, China.|Department of Pediatrics, Dongfang Hospital, Affiliated to Xiamen University, Fuzhou, 350025, China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Pediatrics, Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, 350025, China.|Department of Pediatrics, Clinical Medical College of Fujian Medical University in Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, China.|Department of Pediatrics, Dongfang Hospital, Affiliated to Xiamen University, Fuzhou, 350025, China.
authors.forename: Zhi-wen
authors.initials: ZW
authors.lastname: Sun
authors.affiliation: Department of Pediatrics, Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, 350025, China.|Department of Pediatrics, Clinical Medical College of Fujian Medical University in Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, China.|Department of Pediatrics, Dongfang Hospital, Affiliated to Xiamen University, Fuzhou, 350025, China.
authors.forename: Zeng-feng
authors.initials: ZF
authors.lastname: Weng
authors.affiliation: Department of Pediatrics, Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, 350025, China.|Department of Pediatrics, Clinical Medical College of Fujian Medical University in Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, China.|Department of Pediatrics, Dongfang Hospital, Affiliated to Xiamen University, Fuzhou, 350025, China.
authors.forename: Yu-ying
authors.initials: YY
authors.lastname: Yang
authors.affiliation: Department of Pediatrics, Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, 350025, China.|Department of Pediatrics, Clinical Medical College of Fujian Medical University in Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, China.|Department of Pediatrics, Dongfang Hospital, Affiliated to Xiamen University, Fuzhou, 350025, China.
authors.forename: Shu-lian
authors.initials: SL
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, 350025, China.|Department of Pediatrics, Clinical Medical College of Fujian Medical University in Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, China.|Department of Pediatrics, Dongfang Hospital, Affiliated to Xiamen University, Fuzhou, 350025, China.
authors.forename: Si-rui
authors.initials: SR
authors.lastname: Zheng
authors.affiliation: Department of Pediatrics, Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, 350025, China.|Department of Pediatrics, Clinical Medical College of Fujian Medical University in Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, China.|Department of Pediatrics, Dongfang Hospital, Affiliated to Xiamen University, Fuzhou, 350025, China.
authors.forename: Ying-yun
authors.initials: YY
authors.lastname: Luo
authors.affiliation: Department of Pediatrics, Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, 350025, China.|Department of Pediatrics, Clinical Medical College of Fujian Medical University in Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, China.|Department of Pediatrics, Dongfang Hospital, Affiliated to Xiamen University, Fuzhou, 350025, China.
authors.forename: Yan-ting
authors.initials: YT
authors.lastname: Lu
authors.affiliation: Department of Pediatrics, Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, 350025, China.|Department of Pediatrics, Clinical Medical College of Fujian Medical University in Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, China.|Department of Pediatrics, Dongfang Hospital, Affiliated to Xiamen University, Fuzhou, 350025, China.
authors.forename: Hui-qin
authors.initials: HQ
authors.lastname: Cao
authors.affiliation: Department of Pediatrics, Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, 350025, China.|Department of Pediatrics, Clinical Medical College of Fujian Medical University in Fuzhou General Hospital of Nanjing Military Command, PLA, Fuzhou, Fujian, China.|Department of Pediatrics, Dongfang Hospital, Affiliated to Xiamen University, Fuzhou, 350025, China.
authors.forename: Hai-xia
authors.initials: HX
authors.lastname: Zhan
mesh_terms: D001146:Arrhythmia, Sinus / Q000139:chemically induced / Q000628:therapy; D001784:Blood Gas Analysis; D001919:Bradycardia / Q000139:chemically induced / Q000628:therapy; D002367:Ricinus communis / Q000506:poisoning*; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D010951:Plasma Exchange / Q000379:methods*; D010956:Plasmapheresis / Q000379:methods*; D012276:Ricin / Q000506:poisoning*; D016896:Treatment Outcome; D014839:Vomiting
chemical_list: D012276:Ricin
keywords: pediatric; ricin; ricinus communis; severe; therapy; toxicity