Abrus precatorius L.

1. NAME 1.1 Scientific name 1.2 Family 1.3 Common name(s) 2. SUMMARY 2.1 Main risks an tar!et or!ans 2.2 S"mmary of clinical effects 2.3 #ia!nosis 2.$ First%ai meas"res an mana!ement &rinci&les 2.' (oisono"s &arts 2.) Main to*ins 3. C+ARAC,ER-S,-CS 3.1 #escri&tion of t.e &lant 3.1.1 S&ecial i entification feat"res 3.1.2 +a/itat 3.1.3 #istri/"tion 3.2 (oisono"s &arts of t.e &lant 3.3 ,.e to*in(s) 3.3.1 Name(s) 3.3.2 #escri&tion0 c.emical str"ct"re0 sta/ility 3.3.3 1t.er &.ysico%c.emical c.aracteristics 3.$ 1t.er c.emical contents of t.e &lant $. USES2C-RCUMS,ANCES 1F (1-S1N-N3 $.1 Uses $.2 +i!. risk circ"mstances $.3 +i!. risk !eo!ra&.ical areas '. R1U,ES 1F EN,RY '.1 1ral '.2 -n.alation

'.3 #ermal '.$ Eye '.' (arenteral '.) 1t.ers ). 4-NE,-CS ).1 A/sor&tion /y ro"te of e*&os"re ).2 #istri/"tion /y ro"te of e*&os"re ).3 5iolo!ical .alf%life /y ro"te of e*&os"re ).$ Meta/olism ).' Elimination /y ro"te of e*&os"re 6. ,17-C1813Y2,17-N1813Y2(+ARMAC1813Y 6.1 Mo e of action 6.2 ,o*icity 6.2.1 +"man ata 6.2.1.1 A "lts 6.2.1.2 C.il ren 6.2.2 Animal ata 6.2.3 Rele9ant in 9itro ata 6.3 Carcino!enicity 6.$ ,erato!enicity 6.' M"ta!enicity 6.) -nteractions :. ,17-C1813-CA82,17-N1813-CA8 ANA8YSES AN# 5-1ME#-CA8 -N;ES,-3A,-1NS :.1 Material sam&lin! &lan :.1.1 Sam&lin! an s&ecimen collection :.1.1.1 ,o*icolo!ical analyses :.1.1.2 5iome ical analyses :.1.1.3 Arterial /loo !as analysis :.1.1.$ +aematolo!ical analyses :.1.1.' 1t.er ("ns&ecifie ) analyses

:.1.2 Stora!e of la/oratory sam&les an s&ecimens :.1.2.1 ,o*icolo!ical analyses :.1.2.2 5iome ical analyses :.1.2.3 Arterial /loo !as analysis :.1.2.$ +aematolo!ical analyses :.1.2.' 1t.er ("ns&ecifie ) analyses :.1.3 ,rans&ort of la/oratory sam&les an s&ecimens :.1.3.1 ,o*icolo!ical analyses :.1.3.2 5iome ical analyses :.1.3.3 Arterial /loo !as analysis :.1.3.$ +aematolo!ical analyses :.1.3.' 1t.er ("ns&ecifie ) analyses :.2 ,o*icolo!ical Analyses an ,.eir -nter&retation :.2.1 ,ests on to*ic in!re ient(s) of material :.2.1.1 Sim&le <"alitati9e ,est(s) :.2.1.2 A 9ance <"alitati9e Confirmation ,est(s) :.2.1.3 Sim&le <"antitati9e Met.o (s) :.2.1.$ A 9ance <"antitati9e Met.o (s) :.2.2 ,ests for /iolo!ical s&ecimens :.2.2.1 Sim&le <"alitati9e ,est(s) :.2.2.2 A 9ance <"alitati9e Confirmation ,est(s) :.2.2.3 Sim&le <"antitati9e Met.o (s) :.2.2.$ A 9ance <"antitati9e Met.o (s) :.2.2.' 1t.er #e icate Met.o (s) :.2.3 -nter&retation of to*icolo!ical analyses :.3 5iome ical in9esti!ations an t.eir inter&retation :.3.1 5ioc.emical analysis :.3.1.1 5loo 0 &lasma or ser"m :.3.1.2 Urine :.3.1.3 1t.er fl"i s :.3.2 Arterial /loo !as analyses

:.3.3 +aematolo!ical analyses :.3.$ -nter&retation of /iome ical in9esti!ations :.$ 1t.er /iome ical ( ia!nostic) in9esti!ations an t.eir inter&retation :.' 19erall -nter&retation of all to*icolo!ical analyses an to*icolo!ical in9esti!ations :.) References =. C8-N-CA8 EFFEC,S =.1 Ac"te &oisonin! =.1.1 -n!estion =.1.2 -n.alation =.1.3 Skin e*&os"re =.1.$ Eye contact =.1.' (arenteral e*&os"re =.1.) 1t.er =.2 C.ronic &oisonin! =.2.1 -n!estion =.2.2 -n.alation =.2.3 Skin e*&os"re =.2.$ Eye contact =.2.' (arenteral e*&os"re =.2.) 1t.er =.3 Co"rse0 &ro!nosis0 ca"se of eat. =.$ Systematic escri&tion of clinical effects =.$.1 Car io9asc"lar =.$.2 Res&iratory =.$.3 Ne"rolo!ical =.$.3.1 CNS =.$.3.2 (eri&.eral ner9o"s system =.$.3.3 A"tonomic ner9o"s system =.$.3.$ Skeletal an smoot. m"scle =.$.$ 3astrointestinal

=.$.' +e&atic =.$.) Urinary =.$.).1 Renal =.$.).2 1t.ers =.$.6 En ocrine an re&ro "cti9e systems =.$.: #ermatolo!ical =.$.= Eye0 ears0 nose0 t.roat> local effects =.$.1? +aematolo!ical =.$.11 -mm"nolo!ical =.$.12 Meta/olic =.$.12.1 Aci /ase ist"r/ances =.$.12.2 Fl"i an electrolyte ist"r/ances =.$.12.3 1t.ers =.$.13 Aller!ic reactions =.$.1$ 1t.er clinical effects =.$.1' S&ecial risks =.' 1t.ers =.) S"mmary 1?. MANA3EMEN, 1?.1 3eneral &rinci&les 1?.2 Rele9ant la/oratory analyses an ot.er in9esti!ations 1?.2.1 Sam&le collection 1?.2.2 5iome ical analysis 1?.2.3 ,o*icolo!ical2to*inolo!ical analysis 1?.2.$ 1t.er in9esti!ations 1?.3 8ife s"&&orti9e &roce "res an sym&tomatic treatment 1?.$ #econtamination 1?.' Elimination 1?.) Anti ote2antito*in treatment 1?.).1 A "lts 1?.).2 C.il ren

1?.6 Mana!ement isc"ssion 11. -88US,RA,-;E CASES 11.1 Case re&orts from literat"re 11.2 -nternally e*tracte 11.3 -nternal cases 12. A##-,-1NA8 -NF1RMA,-1N 12.1 A9aila/ility of anti otes2antito*ins 12.2 S&ecific &re9enti9e meas"res 12.3 1t.er 13. REFERENCES 13.1 Clinical an to*icolo!ical 13.2 5otanical 1$. AU,+1R(S)0 RE;-E@ER(S)0 #A,E(S) (-NC8U#-N3 U(#A,ES)0 C1M(8E,E A##RESS(ES) ata on cases

POISONOUS PLANTS 1. NAME 1.1 Scientific name Abrus precatorius L. 1.2 Famil Le!uminosae 1." #ommon name$s% Abrus see& Ai'oeiro Arraccu(mitim )u&&*ist rosar bea& #arolina mui&a #rabs e e +ea&l crab,s e e In&ian bea& In&ian li-uorice .e-uirite .e-uirit )ean .umble bea&s .u-uiriti Luc/ bean Pra er bea&s Precator bean 0osar bea&s 0osar Pea 0uti Tentos &a America Tentos &os mun&os 1eat*er plant 1il& li-uorice 2. SUMMA02 2.1 Main ris/s an& tar!et or!ans

T*e main ris/ is t*e se'ere !astroenteritis lea&in! to &e* &ration an& s*oc/. In!este& see&s can affect t*e !astrointestinal tract3 t*e li'er3 spleen3 /i&ne 3 an& t*e l mp*atic s stem. Infusion of see& e4tracts can cause e e &ama!e after contact. 2.2 Summar of clinical effects T*e earl features of to4icit are burnin! of t*e mout* an& oesop*a!us3 an& se'ere !astroenteritis 5it* 'omitin!3 *aematemesis3 &iarr*oea3 melaena3 an& ab&ominal pain. Later3 &ro5siness3 &isorientation3 5ea/ness3 stupor3 con'ulsions3 s*oc/3 c anosis3 retinal *aemorr*a!es3 *aematuria3 an& oli!uria can occur. #ontact 5it* t*e e es can cause con6uncti'itis an& e'en blin&ness. 2." +ia!nosis +ia!nosis is ma&e b t*e presence of t*e t pical manifestations follo5in! in!estion7 !astroenteritis 5it* ris/ of &e* &ration3 *aematemesis an& melaena. +ro5siness an& con'ulsions ma occur. To4icolo!ical anal sis of bo& *elpful. flui&s for t*e poison is not

Plant material3 see&s or remnants of see&s3 'omitus3 an& !astric aspirate s*oul& be collecte& in clean bottles for i&entification. 2.8 First(ai& measures an& mana!ement principles First(ai& measures7 0emo'e all see& particles from t*e mout*. In&uce 'omitin! an& sa'e it for i&entification. Ensure t*at t*e patient,s air5a is clear an& t*at t*ere is a&e-uate 'entilation. +o not in&uce 'omitin! if t*e patient is semi(conscious or is at ris/ of *a'in! con'ulsions. If t*e e es are contaminate&3 5as* e es 5it* runnin! 5ater for ten minutes. Me&ical attention is essential if t*e see&s 5ere in!este&3 or if t*e e es 5ere contaminate&. #ollect remainin! see&s or plant material or remnants of see&s for i&entification. Mana!ement principles7 in&uce emesis or perform !astric la'a!e. Supporti'e measures inclu&e parenteral flui&s an& electrol tes. 9eep t*e patient in *ospital for se'eral &a s because se'ere s mptoms can &e'elop some time after in!estion. 2.: Poisonous parts T*e most poisonous parts of t*e plant in'ol'e& in poisonin! are t*e small3 scarlet see&s3 t*at *a'e a blac/ e e at t*e *ilum. 2.; Main to4ins T*e main to4in is abrin3 5*ic* is concentrate& in t*e see&s. ". #<A0A#TE0ISTI#S ".1 +escription of t*e plant ".1.1 Special i&entification features Abrus precatorius is a slen&er3 perennial climber t*at t5ines aroun& trees3 s*rubs3 an& *e&!es. It *as no special or!ans of attac*ment. Lea'es are !labrous 5it* lon! interno&es. It *as a slen&er branc* an& a c lin&rical 5rin/le& stem 5it* a smoot*(te4ture& bro5n bar/. Lea'es alternate compoun& paripinnate 5it* stipules. Eac* leaf *as a mi&rib from : to 1= cm lon!. It bears from 2= to 28 or more leaflets3 eac* of 5*ic*

is about 1.2 to 1.> cm lon!3 oblon! an& obtuse. It is blunt at bot* en&s3 !labrous on top an& sli!*tl *air belo5. Flo5ers are small an& pale 'iolet in colour 5it* a s*ort stal/3 arran!e& in clusters. T*e o'ar *as a mar!inal placentation. T*e fruit3 5*ic* is a po&3 is flat3 oblon! an& truncate( s*ape& 5it* a s*arp &efle4e& bea/ is about " to 8.: cm lon!3 1.2 cm 5i&e3 an& sil/ (te4ture&. T*e po& curls bac/ 5*en opene& to re'eal pen&ulous see&s. Eac* fruit contains from " to : o'al(s*ape& see&s3 about =.; cm. T*e are usuall bri!*t scarlet in colour 5it* a smoot*3 !loss te4ture3 an& a blac/ patc* on top. ".1.2 <abitat Abrus precatorius is a 5il& plant t*at !ro5s best in fairl &r re!ions at lo5 ele'ations. ".1." +istribution It !ro5s in tropical climates suc* as In&ia3 Sri Lan/a3 T*ailan&3 t*e P*ilippine Islan&s3 Sout* #*ina3 tropical Africa an& t*e 1est In&ies. It also !ro5s in all tropical or subtropical areas. ".2 Poisonous parts of t*e plant T*e most poisonous part of t*e plant is t*e see&. It is =.; cm lon! $alt*ou!* len!t* ma 'ar %3 an& o'al(s*ape&. It is usuall bri!*t scarlet3 an& *as a 6et(blac/ spot surroun&in! t*e *ilum 5*ic* is t*e point of attac*ment. T*e see& coat3 or testa3 is smoot* an& !loss an& becomes *ar& 5*en t*e see& matures. "." T*e to4in$s% ".".1 Name$s% Abrin3 5*ic* consists of abrus a!!lutinin3 an& to4ic lectins abrins ?a@ to ?&@ are t*e fi'e to4ic !l coproteins foun& in t*e see&s $)u&a'ari3 1A>A%. ".".2 +escription3 c*emical structure3 stabilit Fi'e !l coproteins *a'e been purifie& from t*e see&s. T*e are abrus a!!lutinin $a *aema!!lutinin% an& t*e to4ic principles abrins ?a@ to ?&@. Abrus a!!lutinin is a tetramer 5it* a molecular 5ei!*t of 1"83A==. It is non(to4ic to animal cells an& a potent *aema!!lutinator. Abrins a t*rou!* & $molecular 5ei!*t7 ;"3=== ( ;B3===% are compose& of t5o &isulp*i&e(lin/e& pol pepti&e c*ains. T*e lar!er sub(unit3 5*ic* is t*e neutral )( c*ain *as a molecular 5ei!*t of appro4imatel ":3===. T*e ot*er sub(unit an aci&ic A(c*ain *as a molecular 5ei!*t of appro4imatel "=3=== $1in&*olC3 1A>"D )u&a'ari3 1A>A%. Stabilit 7 Pure abrin is a ello5is*(5*ite amorp*ous po5&er. T*e to4ic portion is *eat(stable to incubation at ;=E# for "= minutes. At >=E# most of t*e to4icit is lost in "= minutes $)u&a'ari3 1A>A%. "."." Ot*er p* sico(c*emical c*aracteristics Pure abrin is a ello5is*(5*ite amorp*ous po5&er. Abrin is soluble in so&ium c*lori&e solutions3 usuall 5it* turbi&it $)u&a'ari3 1A>A%. ".8 Ot*er c*emical contents of t*e plant T*e see&s also contain an amino aci& /no5n as abrine $N(met* l(

L(tr ptop*an%3 !l c rr*iCin an& a lipol tic enC me. T*e roots3 stems3 an& lea'es also contain !l c rr*iCin $1in&*olC3 1A>"%. 8. USESF#I0#UMSTAN#ES OF POISONING 8.1 Uses #*il&ren are attracte& b t*e bri!*tl (coloure& see&s. In some countries t*e pla 5it* t*em an& in sc*ool use t*em in t*eir *an&i5or/ an& to count. Nec/laces an& ot*er ornaments ma&e from t*e see&s are 5orn b bot* c*il&ren an& a&ults. T*e see&s 5ere also use& to treat &iabetes an& c*ronic nep*ritis. T*e plant is also use& in some tra&itional me&icine to treat scratc*es an& sores3 an& 5oun&s cause& b &o!s3 cats3 an& mice3 an& is also use& 5it* ot*er in!re&ients to treat leuco&erma. T*e lea'es are use& for t*eir anti( suppurati'e properties. T*e are !roun& 5it* lime an& applie& on acne sores3 boils3 an& abscesses. T*e plant is also tra&itionall use& to treat tetanus3 an& to pre'ent rabies. Harious African tribes use po5&ere& see&s as oral contracepti'es $1att I )re er3 1A;2%. )oile& see&s of Abrus precatorius are eaten in certain parts of In&ia $0a6aramI .anar&*anan3 1AA2%. 8.2 <i!* ris/ circumstances #*il&ren are attracte& to t*e bri!*tl (coloure& see&s an& ma c*e53 suc/3 or s5allo5 t*em. )ecause of t*e *ar& an& relati'el impermeable coat of t*e mature see&s3 t*e are consi&erabl less to4ic if s5allo5e& 5*ole. T*e are more &an!erous 5*en t*e see&s are c*e5e& or suc/e& because t*e to4ic elements in t*e see&s are e4tracte& an& mi4e& 5it* enC mes. Immature see&s are also poisonous if in!este& because of t*eir soft an& easil bro/en coat. 1*en t*e see&s are use& as ornaments3 suc* as nec/laces3 *oles are &rille& in t*e see&s3 5*ic* allo5s contact bet5een t*e intestinal secretions an& t*e core of t*e see& resultin! in absorption of t*e to4ic in!re&ients. Anot*er reporte& circumstance is t*e &rin/in! of be'era!es 5*ere see&s from a nec/lace *a'e been soa/e& $.ou!lar&3 1ABB%. If s5allo5e&3 t*ese see&s easil cause poisonin!. 8." <i!* ris/ !eo!rap*ical areas T*e *i!*(ris/ areas are t*e &r re!ions an& lo5lan& tropical areas alt*ou!* nec/laces are sol& in man countries. :. 0OUTES OF ENT02 :.1 Oral Abrus precatorius mature or immature see&s are c*e5e& or in!este&. :.2 In*alation Un/no5n. :." +ermal Un/no5n. :.8 E e #ol& preparations ma&e from soa/in! t*e see&s *a'e been use& to treat trac*oma an& corneal opacities $<art3 1A;"%. :.: Parenteral Subcutaneous in6ections from &rie& infusions ma&e from t*e

see&s *a'e been use& to poison li'estoc/ an& *uman bein!s in In&ia $<art3 1A;"%. :.; Ot*ers Un/no5n. ;. 9INETI#S ;.1 Absorption b route of e4posure Abrin is 'er stable in t*e !astrointestinal tract3 from 5*ere it is slo5l absorbe&. It is consi&erabl less to4ic after oral a&ministration t*an after parenteral in6ection Gunsolus3 1A::%. ;.2 +istribution b route of e4posure Abrin is 5i&el &istribute& in tissues. ;." )iolo!ical *alf(life b route of e4posure Un/no5n. ;.8 Metabolism Un/no5n. ;.: Elimination b route of e4posure Un/no5n. B. TOJI#OLOG2FTOJINOLOG2FP<A0MA#OLOG2 B.1 Mo&e of action Abrin e4erts its to4ic action b attac*in! itself to t*e cell membranes. Abrin,s to4ic effect is &ue to its &irect action on t*e parenc* mal cells $e.!.3 li'er an& /i&ne cells% an& re& bloo& cells $<art3 1A;"%. )ot* subunits from 5*ic* abrins ?a@ t*rou!* ?&@ are ma&e up are re-uire& for its to4ic effects. T*e lar!er subunit3 t*e ) c*ain $*aptomere% bin&s to t*e !alactos l(terminate& receptors on t*e cell membrane3 5*ic* is a prere-uisite for t*e entr of t*e ot*er subunit3 t*e A c*ain $effectomere%. T*is inacti'ates t*e ribosomes3 arrests protein s nt*esis3 an& causes cell &eat* $Stirpe I )arbieri3 1A>;%. T*e A(c*ain attac/s t*e ;=S subunit of t*e ribosomes an& b cuttin! out elon!ation factor EF23 stops protein s nt*esis $Fra*ne I Pfan&er3 1A>"%. Abrus a!!lutinin a!!lutinates t*e re& bloo& cells b combinin! 5it* t*e cell stroma $<art3 1A;"%. B.2 To4icit B.2.1 <uman &ata B.2.1.1 A&ults One see& 5ell masticate& can cause fatal poisonin! $)u&a'ari3 1A>A%. B.2.1.2 #*il&ren One see& 5ell masticate& can cause fatal poisonin! $)u&a'ari3 1A>A%. B.2.2 Animal &ata Abrin,s to4icit *as been teste& in &ifferent animals 5it* 5i&el &i'er!ent results. T*e let*al &ose for animals is about =.=1 m!F/! bo& 5ei!*t $Gunsolus3 1A::%. T*e intra(peritoneal L+:= 'alue in mice is =.=2 m!F/! bo& 5ei!*t $)u&a'ari3 1A>"%. T*e intra'enous minimal let*al &ose of abrin in mice is =.B micro!ramsF/! $Ellen*orn3 1A>>%. Simpson et al. report t*at 2 ounces of see&s are fatal to *orses3 but t*at co5s3 !oats an& &o!s are more resistant. T*e s mptoms reporte& are anore4ia3 'iolent 'omitin!3 lassitu&e3 c*ills3 an& incoor&ination. Se'ere !astroenteritis is also common in animals $Gosselin3 1A>8%.

B.2." 0ele'ant in 'itro &ata No &ata a'ailable. B." #arcino!enicit Un/no5n. B.8 Terato!enicit Un/no5n. B.: Muta!enicit Un/no5n. B.; Interactions Un/no5n. >. TOJI#OLOGI#ALFTOJINOLOGI#AL ANAL2SES AN+ )IOME+I#AL INHESTIGATIONS >.1 Material samplin! plan >.1.1 Samplin! an& specimen collection >.1.1.1 To4icolo!ical anal ses >.1.1.2 )iome&ical anal ses >.1.1." Arterial bloo& !as anal sis >.1.1.8 <aematolo!ical anal ses >.1.1.: Ot*er $unspecifie&% anal ses >.1.2 Stora!e of laborator samples an& specimens >.1.2.1 To4icolo!ical anal ses >.1.2.2 )iome&ical anal ses >.1.2." Arterial bloo& !as anal sis >.1.2.8 <aematolo!ical anal ses >.1.2.: Ot*er $unspecifie&% anal ses >.1." Transport of laborator samples an& specimens >.1.".1 To4icolo!ical anal ses >.1.".2 )iome&ical anal ses >.1."." Arterial bloo& !as anal sis >.1.".8 <aematolo!ical anal ses >.1.".: Ot*er $unspecifie&% anal ses >.2 To4icolo!ical Anal ses an& T*eir Interpretation >.2.1 Tests on to4ic in!re&ient$s% of material >.2.1.1 Simple Kualitati'e Test$s% >.2.1.2 A&'ance& Kualitati'e #onfirmation Test$s% >.2.1." Simple Kuantitati'e Met*o&$s% >.2.1.8 A&'ance& Kuantitati'e Met*o&$s% >.2.2 Tests for biolo!ical specimens >.2.2.1 Simple Kualitati'e Test$s% >.2.2.2 A&'ance& Kualitati'e #onfirmation Test$s% >.2.2." Simple Kuantitati'e Met*o&$s% >.2.2.8 A&'ance& Kuantitati'e Met*o&$s% >.2.2.: Ot*er +e&icate& Met*o&$s% >.2." Interpretation of to4icolo!ical anal ses >." )iome&ical in'esti!ations an& t*eir interpretation >.".1 )ioc*emical anal sis >.".1.1 )loo&3 plasma or serum >.".1.2 Urine >.".1." Ot*er flui&s >.".2 Arterial bloo& !as anal ses >."." <aematolo!ical anal ses >.".8 Interpretation of biome&ical in'esti!ations >.8 Ot*er biome&ical $&ia!nostic% in'esti!ations an& t*eir interpretation >.: O'erall Interpretation of all to4icolo!ical anal ses an& to4icolo!ical in'esti!ations >.; 0eferences A. #LINI#AL EFFE#TS A.1 Acute poisonin! A.1.1 In!estion S mptoms an& si!ns can occur after a latent perio& t*at

ran!es from a fe5 *ours to se'eral &a s. T*e inclu&e a burnin! sensation in t*e mout*3 & sp*a!ia3 nausea3 'omitin!3 bloo& &iarr*oea3 an& ab&ominal cramps. +ro5siness3 &isorientation3 con'ulsions3 c anosis3 stupor3 circulator failure3 retinal *aemorr*a!es3 *aematuria an& oli!uria ma occur. A.1.2 In*alation Un/no5n. A.1." S/in e4posure Un/no5n. A.1.8 E e contact E e irritation lea&s to a &ose(relate& reaction ran!in! from mil& con6uncti'itis to a se'ere &ama!e $<art3 1A;"%. A.1.: Parenteral e4posure T*e clinical effects after intra'enous an& subcutaneous a&ministration are similar to in!estion but !astrointestinal s mptoms are lesser. T*ere is se'ere inflammation at t*e in6ection site. A.1.; Ot*er Un/no5n. A.2 #*ronic poisonin! A.2.1 In!estion Un/no5n. A.2.2 In*alation Un/no5n. A.2." S/in e4posure Un/no5n. A.2.8 E e contact Un/no5n. A.2.: Parenteral e4posure Un/no5n. A.2.; Ot*er Un/no5n. A." #ourse3 pro!nosis3 cause of &eat* T*e ma6or s mptoms of poisonin! are acute !astroenteritis 5it* nausea3 'omitin! an& &iarr*oea lea&in! to &e* &ration3 con'ulsions3 an& s*oc/. +e* &ration3 as 5ell as &irect to4icit on t*e /i&ne s3 coul& result in oli!uria t*at mi!*t pro!ress to &eat* in uraemia. T*e fatalit rate is appro4imatel :L.

0eporte& fatalities occurre& after a " to 8 &a course c*aracteriCe& b persistent !astroenteritis $Ellen*orn3 1A>>%. +eat* ma occur up to 18 &a s after poisonin! from uraemia $+reisbac* I 0obertson3 1A>B%. A.8 S stematic &escription of clinical effects A.8.1 #ar&io'ascular T*ere is no &irect effect on t*e *eart. S*oc/3 * potension3 an& tac* car&ia ma occur after prolon!e& 'omitin! an& &iarr*oea. A.8.2 0espirator # anosis secon&ar to * potension an& s*oc/ ma be seen. A.8." Neurolo!ical A.8.".1 #NS +ro5siness3 con'ulsions3 *allucinations3 an& tremblin! of t*e *an&s. A.8.".2 Perip*eral ner'ous s stem

A.8.8

A.8.:

A.8.;

A.8.B A.8.> A.8.A

Un/no5n. A.8."." Autonomic ner'ous s stem Un/no5n. A.8.".8 S/eletal an& smoot* muscle Un/no5n. Gastrointestinal )ecause of abrin,s irritant action3 se'ere !astroenteritis 5it* nausea3 'omitin!3 &iarr*oea3 & sp*a!ia an& ab&ominal cramps ma occur. Nausea an& 'omitin! are &ue to &irect irritation of t*e !astric mucosa. Erosion of t*e intestinal mucosa can cause *aematemesis an& melaena. <epatic T*e necrotiCin! action of t*e to4in causes li'er &ama!e. Serum le'els of li'er cell enC mes3 i.e.3 aspartate( transferase $AST%3 alanine(transferase $ALT%3 an& lactic &e* &ro!enase $L+<% are mar/e&l increase&. T*e serum bilirubin le'el is ele'ate& in&icatin! pro!ression of t*e lesions. < po!l caemia ma occur. Urinar A.8.;.1 0enal Oli!uria an& anuria ma result from prolon!e& * potension3 but ma also be &ue to acute renal failure as a result of focal &e!eneration of t*e tubular cells. )loc/in! of t*e tubules 5it* *aemo!lobin from *aemol se& re& cells ma also contribute to renal failure. A.8.;.2 Ot*ers Un/no5n. En&ocrine an& repro&ucti'e s stems Un/no5n. +ermatolo!ical S/in contact ma cause irritation an& &ermatitis. E e3 ears3 nose3 t*roat7 local effects E e7 0etinal *aemorr*a!es can appear earl in t*e course of into4ication. T*e patient ma complain of impaire& 'ision t*at is cause& b c*an!es in t*e retina. E e contact can cause se'ere s5ellin! an& re&&enin! of t*e ocular con6uncti'a.

Ear3 nose3 t*roat7 Irritation of t*e t*roat ma occur after in!estion. A.8.1= <aematolo!ical Abrus a!!lutinin causes *aema!!lutination an& *aemol sis b its &irect effect on re& cells. )loo& loss ma also occur because of *aemorr*a!es in t*e !astrointestinal tract. A.8.11 Immunolo!ical Un/no5n. A.8.12 Metabolic A.8.12.1 Aci& base &isturbances Prolon!e& 'omitin! ma cause al/alosis. S*oc/ is li/el to lea& to aci&osis. Aci&osis can also occur from renal failure. A.8.12.2 Flui& an& electrol te &isturbances Homitin!3 &iarr*oea3 an& *aemorr*a!es lea& to loss of flui&s an& electrol tes3 t*us causin! let*ar! 3 muscle 5ea/ness3 car&iac & sr* t*mias3 an& muscle cramps.

A.8.12." Ot*ers Li'er &ama!e ma cause * po!l caemia. A.8.1" Aller!ic reactions Un/no5n. A.8.18 Ot*er clinical effects Un/no5n. A.8.1: Special ris/s Un/no5n. A.: Ot*ers A.; Summar 1=. MANAGEMENT 1=.1 General principles T*e mana!ement of poisonin! cases is mainl s mptomatic an& supporti'e. In&uce& emesis or !astric la'a!e are usuall in&icate& $if t*e con&itions of t*e patient allo5 t*e proce&ures% to remo'e t*e see&s from t*e stomac*. Flui& an& electrol te imbalances s*oul& be carefull monitore& an& correcte&. 1=.2 0ele'ant laborator anal ses an& ot*er in'esti!ations 1=.2.1 Sample collection #ollect t*e see&s or an ot*er plant material for i&entification3 also collect t*e 'omitus or !astric contents in a clean 6ar. See&s ma be i&entifie& if 'omitus is put insi&e a transparent plastic ba!. 1=.2.2 )iome&ical anal sis Full bloo& count3 li'er profile3 serum electrol tes bloo& !ases3 bloo& urea an& creatinine are t*e essential anal ses. Urinal sis ma re'eal t*e presence of protein3 re& bloo& cells3 *aemo!lobin3 an& casts. 1=.2." To4icolo!icalFto4inolo!ical anal sis No simple anal ses are a'ailable in practice. 1=.2.8 Ot*er in'esti!ations Ma be in&icate& accor&in! to t*e patient,s con&ition. 1=." Life supporti'e proce&ures an& s mptomatic treatment Ma/e a proper assessment of air5a 3 breat*in!3 circulation an& neurolo!ical status of t*e patient. Monitor 'ital si!ns. Maintain a clear air5a . A&minister o4 !en if t*e patient is in s*oc/. Monitor aci& base balance3 an& flui& an& electrol te balance. Gi'e a&e-uate oral flui&s b mout*3 if possible. If t*e patient is unable to s5allo53 a&minister intra'enous flui&s an& electrol tes3 accor&in! to t*e se'erit of t*e s mptoms an& t*e results of serum electrol te anal sis. #orrect metabolic aci&osis if present. Flui& loss ma lea& to * po'olaemic s*oc/ 5it* * potension. If t*e intra'enous flui& t*erap &oes not raise t*e bloo& pressure3 insert a central 'enous pressure line an& !i'e plasma or &e4tran to e4pan& t*e intra'ascular 'olume. If * potension still persists consi&er a&ministration of &opamine or &obutamine in a continuous infusion.

No cases of se'ere *aemol sis *a'e been reporte&. <o5e'er3 if si!nificant *aemol sis occurs3 an& if /i&ne function is normal3 maintain t*e urine output at o'er 1== mlF*our 5it* al/aline flui&s. If anuria persists after recei'in! flui& replacement3 consi&er t*e possibilit of &ial sis. If con'ulsions occur3 a&minister anti(con'ulsant &ru!s $&iaCepam3 intra'enousl or intrarectall in pae&iatric emer!encies%. +emulcents ma relie'e orop*ar n!eal an& !astric irritation. 1=.8 +econtamination Emesis 5it* s rup of ipecacuan*a is t*e best 5a to remo'e t*e see&s or pieces of plant from t*e stomac* unless contrain&ications to in&uce& emesis e4ist or orp*ar n!eal oe&ema is present. If emesis in&uction is not possible3 !astric la'a!e ma be performe& if t*e con&ition of t*e patient allo5s it. If t*e patient is obtun&e&3 con'ulsin! or comatose3 insert an oro( or naso(!astric tube an& la'a!e after en&otrac*eal intubation. #at*artics s*oul& not be use& because t*e &iarr*oea an& flui& loss. can a!!ra'ate

In case of e e e4posure3 irri!ate e es 5it* copious amounts of 5ater or saline. 1=.: Elimination No met*o& *as pro'e& to be beneficial. 1=.; Anti&oteFantito4in treatment 1=.;.1 A&ults T*ere is no specific anti&ote a'ailable. An anti(serum use& to be supplie& un&er t*e name of Manti(abrinM or M6e-uiritolM $Gunsolus3 1A::% but is no lon!er a'ailable. 1=.;.2 #*il&ren T*ere is no specific anti&ote a'ailable. An anti(serum use& to be supplie& un&er Manti(abrinM or M6e-uiritolM $Gunsolus3 no lon!er a'ailable. 1=.B Mana!ement &iscussion Gastric la'a!e ma be &ifficult to perform an& successful if t*e siCe of t*e see&s is lar!e. emesis ma be preferre&. t*e name of 1A::% but is ma not be In&uction of

A cat*artic can be a&ministere& to accelerate intestinal transit in cases 5*ere entire see&s *a'e been recentl in!este& an& no clinical features of poisonin! are present. #at*artics are contrain&icate& in t*e s mptomatic patient. Ma!nesium sulp*ate s*oul& be a'oi&e& 5*en !astrointestinal irritation is present because it ma be absorbe& s stemicall . 11. ILLUST0ATIHE #ASES 11.1 #ase reports from literature A&ults7 Some in'esti!ators *a'e reporte& t*at abrin is

poorl absorbe& from t*e intestine. <o5e'er3 t*ere *a'e been reports of se'ere3 sublet*al to4icit in a&ults after in!estion of onl one(*alf to t5o see&s $<art3 1A;"%. A "B( ear(ol& man 5as se'erel a see& $Gunsolus3 1A::%. poisone& after in!estin! *alf

A 1A( ear(ol& !irl &ie& after s*e 5as treate& for trac*oma 5it* 6e-uirit infusions $Gunsolus3 1A::%. An a&ult3 5*o *omo!eniCe& 2= see&s in a blen&er an& a portion of t*e mi4ture &ie& $+a'is3 1AB>%. #*il&ren7 +eat*s in c*il&ren *a'e been reporte& in Flori&a3 USA3 in 1A8A3 1A:> an& 1A;2 after in!estion of one or more see&s. In 1A::3 t5o see&s cause& se'ere but non(fatal poisonin! $<art3 1A;"%. In Missouri3 USA3 a c*il& 5*o in!este& e4actl one(*alf see& 5as imme&iatel ma&e force& to 'omit. T*e remain&er of t*e s5allo5e& *alf see&3 5*ose coat 5as bro/en3 5as foun& in t*e 'omitus. <e 5as treate& imme&iatel an& &i& not &e'elop an s mptoms $9inamore3 1A>=%. In most of t*e cases3 t*e -uantit of t*e see& in!este& *as been &escribe& as t*e potentiall let*al &ose in c*il&ren. 11.2 Internall e4tracte& &ata on cases To be a&&e& b t*e centre. 11." Internal cases To be a&&e& b t*e centre. 12. A++ITIONAL INFO0MATION 12.1 A'ailabilit of anti&otesFantito4ins No anti&otes are a'ailable at present. 12.2 Specific pre'enti'e measures +o not allo5 c*il&ren to pla 5it* see&s of Abrus precatorius. 9eep see&s or ornaments ma&e out of see&s a5a c*il&ren. from

+o not !ro5 Abrus precatorius plants in *ome !ar&ens. E&ucate ol&er c*il&ren an& t*e public of t*e &an!ers of in!estin! see&s. 12." Ot*er No &ata a'ailable. 1". 0EFE0EN#ES 1".1 #linical an& to4icolo!ical )u&a'ari S e&. $1A>A% T*e Merc/ In&e47 an enc clope&ia of c*emicals3 &ru!s3 an& biolo!icals3 1=t* e&. 0a*5a 3 Ne5 .erse 3 Merc/ an& #o.3 Inc. +a'is .< $1AB>% Abrus precatorius $rosar pea%. T*e most common let*al plant poison. .ournal of Flori&a Me&ical Association3 ;:7 1>A(1A1. +reisbac* 0< I 0obinson 1O e&s. $1A>B% <an&boo/ of Poisonin!7 Pre'ention3 +ia!nosis I Treatment3 Los Altos3 #alifornia3 Appleton an& Lan!e. p 8AB. Ellen*orn M. I )arcelou4 +G. e&s $1A>>%. Me&ical To4icolo! . Ne5 2or/3 Else'ier Science Publis*in! #ompan 3 Inc. 1228(

122:. Gosselin 0E3 Smit* 0P3 I <o&!e <# $1A>8% e&. #linical To4icolo! of #ommercial Pro&ucts3 )altimoreFLon&on3 1illiams I 1il/ins. Gunsolus .M $1A::%. To4icit Me& Assoc3 1:B7 BBA. <art M $1A;"%. 2;>7 >>:(>>;. .e-uirit of .e-uirit beans. . Amer

bean Poisonin!.

N En!l . Me&3

<oe*ne F# $1AB>%. Planta4e substancias 'e!etais to4icase me&icinais. Sao Paulo3 No'os <oriContes3 "::p .ou!lar& . $1ABB%. Into4ications &,ori!ine 'e!etale In7 Enc cl. Me&. #*ir.D Into4ication Paris3 E&itions Tec*ni-ues3 1;=;: A(1=(A(2=. 9inamore PA3 .a!er 013 +e #astro F.3 I Pec/ 9O $1A>=%. Abrus I 0icinus In!estion7 Mana!ement of t*ree cases. #linical To4icolo! 3 1B$"%7 8=1(8=:. 9un/el +) $1A>"%. Poisonous Plants in7 <a&&a& LM I 1inc*ester .F. e&. #linical Mana!ement of Poisonin! I +ru! O'er&osa!e3 #ana&a3 1.). Saun&ers #ompan . pp 1=12. Lampe 9F $1AB;%. #*an!es in t*erap in Abrus precatorius I 0icinus communis poisonin! su!!este& b recent stu&ies in t*eir mec*anism of To4icit . #linical To4icolo! 3 A$1%7 21. Lin .23 Tsern!3 923 #*en ##3 Lin LT3 I Tun! T# $1AB=%. Abrin I 0icin7 Ne5 Anti(tumour Substances. Nature3 22B7 2A2 ( 2A". 0e nol&s .EF3 e& $1A>2% Martin&ale3 T*e E4tra P*armacopoeia3 2>t* e&. Lon&on3 P*armaceutical Press3 p 2=2: 0a6aram N I .anar&*anan 9 $1AA2% T*e c*emical composition an& nutritional potential of t*e tribal pulse3 Abrus precatorius L. Plant Foo&s <um Nutr3 82$8%7 2>:(2A=. Sc*'artsman S $1ABA% Plantas 'enenosas. Sao Paulo3 Sar'ier.

Stripe F I )arbieri L $1A>;%. S mposium7 Molecular Mec*anisms of To4icit 3 To4ic Lectins from Plants. <uman To4icolo! 3 :$2%7 1=>(1=A. 1in&*olC M. e& $1A>"% T*e Merc/ In&e47 an enc clope&ia of c*emicals3 &ru!s3 an& biolo!icals3 1=t* e&. 0a*5a 3 Ne5 .erse 3 Merc/ an& #o.3 Inc. 1".2 )otanical Fro*ne + I Pfan&er <. $1A>"% e&. A #olour Atlas of Poisonous Plants3 German 3 1olfe Publis*in! Lt&. pp 2A1. 18. AUT<O0$S%3 0EHIE1E0$S%3 +ATE$S% $IN#LU+ING UP+ATES%3 #OMPLETE A++0ESS$ES% Aut*or7 +r 0a'in&ra Fernan&o National Poisons Information #entre Facult of Me&icine 9 nse 0oa&

#olombo > Sri Lan/a Tel7 A8(1(A8=1; Fa47 A8(1(:AA2"1 +ate7 September 1A>>

0e'ie5er7 +r A. Furta&o 0a*&e Poisons #ontrol #entre 0ua 0iac*uelo ;BBF2=1 A=1== Porto Ale!re )raCil Tel7 ::(:12(2B:81A Fa47 ::(:12("A1:;8 +ate7 No'ember 1A>> Lon&on3 Unite& 9in!&om3 Marc* 1AA=

Peer 0e'ie57 Up&ate7 0e'ie57

+r 0. Fernan&o3 Lon&on3 Unite& 9in!&om3 .une 1AA" IP#S3 Ma 1AA8

See Also7 To4icolo!ical Abbre'iations

http://www.inchem.org/documents/pims/plant/abruspre.htm Abrin murni adalah bubuk amorf putih kekuningan. Bagian beracun adalah panas yang stabil untuk inkubasi pada 60 C selama 0 menit. !ada "0 C sebagian besar toksisitas hilang dalam 0 menit