Symptoms: While many exposures have mild to moderate symptoms before resolution, severe symptoms may develop. After seeds are eaten, if symptoms occur, they usually develop in hours or days, Initially, the findings are suggestive of viral gastroenteritis. A retrospective analysis of 112 cases supports the most common initial symptoms are GI: nausea, vomiting, severe abdominal pain and bloody diarrhea-pharyngeal pain with ulcerative lesions of mouth and esophagus can develop. Severe symptoms include prostration, hallucinations, cerebral edema and seizures; fatal exposures will develop hypotension, high heart rates, shock and fever; ultimately with multi-organ failure-renal, CNS, and liver.

Management/Treatment

• General: Avoidance and education. These include don’t buy the poison seed bracelet, don’t put the poison seeds in your mouth.
• GI decontamination: If early in exposure (e.g. just happened or suspected ingestion prior to onset of symptoms) activated charcoal with WBI may be considered. Ipecac use with cathartics has been previously described. Antiemetics, fluid resuscitation for volume and electrolyte repletion as needed.
• Laboratory assessment: serial evaluations for electrolyte derangement, LFTs, renal function, assessment of mental status.

There is no antidote for abrin poisoning-care is primarily supportive.

The author thanks the brilliant and observant Dr. Jordan Celeste of Central Florida, who sent him seeds that were growing wild in her neighborhood.

Dr. Hack is chief of the division of medical toxicology and vice chair for research at East Carolina University in Greenville, North Carolina

References

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