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Abrin Poisoning Case Study: Rosary Pea Seed Toxicology

A clinical toxicology case study covering mechanism, symptoms, and intensive care management of massive abrin ingestion from rosary pea seeds.

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Abrin Poisoning: A Case of Deliberate Self-Poisoning with Rosary Pea Seeds
28M | Massive Abrin Ingestion | Multiorgan Failure
April 2025 | Emergency & Critical Care Toxicology
Made byBobr AI
CASE PRESENTATION
Initial Presentation
Patient Demographics & Exposure
Patient: 28-year-old male, 130 kg (BMI elevated)
Timeline: Ingestion on Saturday 18 April (post-midnight), delayed ED presentation on Monday 20 April (~48 hrs post-ingestion)
Primary Exposure: 150 rosary pea seeds (Abrus precatorius) — crushed & blended with water, drank ~¾ of mixture
Co-exposure: 1 kg "gunja powder" (contains abrin), obtained online
Intent: Deliberate self-poisoning (suicidal attempt following online research)
Symptoms on Arrival
Onset of vomiting & diarrhoea beginning 2 hours post-ingestion
Progressive worsening over the 2 days prior to presentation
Presented with persistent vomiting and black, watery diarrhoea
Evidence of severe clinical dehydration
Regular Medications: Quetiapine, Agomelatine, Sertraline
Heart Rate
140 bpm
Blood Pressure
108/66 mmHg
GCS
15 (Alert)
Weight
130 kg
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TOXICOLOGY
Abrin: Mechanism & Clinical Toxicity

What is Abrin?

  • Ribosome-inactivating protein (RIP type II)
  • Derived from Abrus precatorius (Rosary Pea / Jequirity Bean)
  • Similar mechanism to Ricin
  • A-chain: inhibits protein synthesis (halts ribosomal elongation factor EF-2)
  • B-chain: lectin — facilitates cell entry
  • Cellular toxin → widespread cell death

Clinical Features

  • Delayed onset: toxicity up to 3–5 days post-ingestion
  • Haemorrhagic gastroenteritis
  • Haemolysis
  • Acute kidney injury / Renal failure
  • Hepatotoxicity (liver failure)
  • Coagulopathy
  • Raised ICP / Papilloedema (case reports)
  • Seizures
  • Multiorgan failure

Key Facts

  • 1–2 seeds reported potentially fatal in adults
  • Lethal dose poorly defined
  • No antidote exists
  • Toxicity delayed — "quiescent phase" then deterioration
  • Most literature: case reports only (publishing bias toward fatality)
  • 1 survivor reported after 20 seeds → multiorgan failure
Reference: Kumar et al. PMCID: PMC10234767 — 'Fatal Curiosity: A Case of Suicidal Attempt by Abrus Seeds Consumption Through Online Research'
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INVESTIGATIONS
Bloods & Imaging on Arrival (20 April)
VBG & Bloods
7.23
(↓)
pH
14 mmol/L
(↓)
Bicarb
Elevated
(↑)
Lactate
114 mmol/L
(↓↓ CRITICAL)
Na
113 mmol/L
(↑)
Cl
4.9 mmol/L
Normal
K
295 µmol/L
(↑↑)
Creatinine
24
(↓↓)
eGFR
< 25
(Negative)
Paracetamol
Normal
No derangement
LFTs
Imaging (CTAP)
• No pneumatosis intestinalis
• No evidence of bowel perforation
CXR
No pulmonary oedema on initial chest X-ray
* Formal pathology reviewed 20/4 21:30
April 2025 | Emergency & Critical Care Toxicology
Made byBobr AI
CLINICAL TIMELINE
Disease Course & Key Events
SAT 18 APR
Midnight
Ingestion of 150 blended rosary peas + gunja powder
SUN 19 APR
2h post-ingestion
Onset: vomiting & abdominal pain
20x diarrhoea
MON 20 APR
Afternoon
Delayed ED presentation
Day 2 post-ingestion
VBG: pH 7.23, Bicarb 14
Cr 295, Na 114
NAC commenced
(free radical scavenger)
MON 20 APR
21:30
ICU admission
Day 1 ICU
eGFR 24, Cr 258
pH 7.17, Bicarb 17
Lactate 5.5, rising
TUE 21 APR
AM
Brief improvement
Day 2 ICU — Quiescent phase
• Off vasopressors
• Cr improving to 110
NAC continued
Activated charcoal commenced
WED 22 APR
AM
Rapid deterioration
Day 3 ICU
Bloody diarrhoea
CT: diffuse enteritis + ileus
Vasopressors restarted
(Norad 30 + Vasopressin)
• GCS dropped to 10
• Hypoxia on HFNP
WED 22 APR
16:00
Intubated for hypoxia / APO
Abdominal compartment syndrome
→ OT decompression
Not ECMO candidate
GOC B — guarded prognosis
★ Quiescent phase Day 2 — characteristic of abrin toxicity
ℹ Toxin now intracellular — no role for enhanced elimination
April 2025 | Emergency & Critical Care Toxicology
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Management
Treatment Approach — Supportive Care Principles
What We Did
Aggressive IV fluid resuscitation (matching GI losses)
NAC: 200mg/kg → 100mg/kg over 16h (free radical scavenger — in vitro evidence only)
MDAC: 10g every 3h via NGT (if tolerated)
Vitamin K 10mg IV daily (coagulopathy)
Vasopressors: Noradrenaline + Vasopressin
HFNP → Intubation (respiratory failure/APO)
ICU escalation, EPS/Psychiatry referral
Haematology consult (FFP for rising APTT/INR)
Decompressive laparotomy (abdominal compartment syndrome)
Not Recommended / Rationale
Dialysis for enhanced elimination — NOT indicated (toxin intracellular)
Charcoal haemoperfusion — insufficient evidence (1 case report only)
ECMO — not a candidate
FFP — monitoring in progress
Multidisciplinary approach: Toxicology + ICU + Psychiatry | DW Andis Graudins, Toxicologist HML, ICU Consultant Girish
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TEACHING POINTS
Key Learning Points — Abrin Poisoning
Delayed Toxicity
Toxicity may be delayed 3–5 days. Quiescent phase post initial GI symptoms can be misleading — anticipate deterioration.
Massive Ingestion
Literature: 1–2 seeds potentially fatal in adults. This patient ingested ~150 seeds. Most evidence from case reports (publication bias toward fatality).
No Antidote
No specific antidote exists. NAC used as free radical scavenger (in vitro/animal data only). Aggressive supportive care is the mainstay.
Multiorgan Failure Pattern
Sequence: haemorrhagic gastroenteritis → AKI → coagulopathy → hepatotoxicity → CNS effects → respiratory failure → vasodilatory shock.
No Enhanced Elimination
Toxin is intracellular — dialysis and haemoperfusion do not remove abrin. RRT only for renal support. Haemoperfusion not recommended.
Online Accessibility
Seeds purchasable online. Novel route of DSP. Requires toxicology + ICU + psychiatry involvement. Awareness among clinicians is critical.
Ref: Kumar et al. PMC10234767 | CRRT + Haemoperfusion case report PMC
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Abrin Poisoning Case Study: Rosary Pea Seed Toxicology

A clinical toxicology case study covering mechanism, symptoms, and intensive care management of massive abrin ingestion from rosary pea seeds.

Toxicology Teaching Case

Abrin Poisoning: A Case of Deliberate Self-Poisoning with Rosary Pea Seeds

28M | Massive Abrin Ingestion | Multiorgan Failure

April 2025 | Emergency & Critical Care Toxicology

CASE PRESENTATION

Initial Presentation

Patient Demographics & Exposure

28-year-old male, 130 kg (BMI elevated)

Ingestion on Saturday 18 April (post-midnight), delayed ED presentation on Monday 20 April (~48 hrs post-ingestion)

150 rosary pea seeds (Abrus precatorius) — crushed & blended with water, drank ~¾ of mixture

1 kg "gunja powder" (contains abrin), obtained online

Deliberate self-poisoning (suicidal attempt following online research)

Symptoms on Arrival

Onset of vomiting & diarrhoea beginning 2 hours post-ingestion

Progressive worsening over the 2 days prior to presentation

Presented with persistent vomiting and black, watery diarrhoea

Evidence of severe clinical dehydration

Quetiapine, Agomelatine, Sertraline

Heart Rate

140

bpm

Blood Pressure

108/66

mmHg

GCS

15

(Alert)

Weight

130

kg

TOXICOLOGY

Abrin: Mechanism & Clinical Toxicity

What is Abrin?

Clinical Features

Key Facts

Reference: Kumar et al. PMCID: PMC10234767 — 'Fatal Curiosity: A Case of Suicidal Attempt by Abrus Seeds Consumption Through Online Research'

INVESTIGATIONS

Bloods & Imaging on Arrival (20 April)

VBG & Bloods

7.23

(↓)

14

(↓)

Elevated

(↑)

114

(↓↓ CRITICAL)

113

(↑)

4.9

Normal

295

(↑↑)

24

(↓↓)

< 25

(Negative)

Normal

No derangement

Imaging (CTAP)

No pneumatosis intestinalis

No evidence of bowel perforation

CXR

No pulmonary oedema on initial chest X-ray

* Formal pathology reviewed 20/4 21:30

April 2025 | Emergency & Critical Care Toxicology

CLINICAL TIMELINE

Disease Course & Key Events

SAT 18 APR

Midnight

Ingestion of 150 blended rosary peas + gunja powder

SUN 19 APR

2h post-ingestion

Onset: vomiting & abdominal pain

20x diarrhoea

MON 20 APR

Afternoon

Delayed ED presentation

Day 2 post-ingestion

VBG: pH 7.23, Bicarb 14

Cr 295, Na 114

NAC commenced

(free radical scavenger)

MON 20 APR

21:30

ICU admission

Day 1 ICU

eGFR 24, Cr 258

pH 7.17, Bicarb 17

Lactate 5.5, rising

TUE 21 APR

AM

Brief improvement

Day 2 ICU — Quiescent phase

Off vasopressors

Cr improving to 110

NAC continued

Activated charcoal commenced

WED 22 APR

AM

Rapid deterioration

Day 3 ICU

Bloody diarrhoea

CT: diffuse enteritis + ileus

Vasopressors restarted

(Norad 30 + Vasopressin)

GCS dropped to 10

Hypoxia on HFNP

WED 22 APR

16:00

Intubated for hypoxia / APO

Abdominal compartment syndrome

→ OT decompression

Not ECMO candidate

GOC B — guarded prognosis

Quiescent phase Day 2 — characteristic of abrin toxicity

Toxin now intracellular — no role for enhanced elimination

April 2025 | Emergency & Critical Care Toxicology

Management

Treatment Approach — Supportive Care Principles

What We Did

Not Recommended / Rationale

Multidisciplinary approach: Toxicology + ICU + Psychiatry | DW Andis Graudins, Toxicologist HML, ICU Consultant Girish

TEACHING POINTS

Key Learning Points — Abrin Poisoning

Delayed Toxicity

Toxicity may be delayed 3–5 days. Quiescent phase post initial GI symptoms can be misleading — anticipate deterioration.

Massive Ingestion

Literature: 1–2 seeds potentially fatal in adults. This patient ingested ~150 seeds. Most evidence from case reports (publication bias toward fatality).

No Antidote

No specific antidote exists. NAC used as free radical scavenger (in vitro/animal data only). Aggressive supportive care is the mainstay.

Multiorgan Failure Pattern

Sequence: haemorrhagic gastroenteritis → AKI → coagulopathy → hepatotoxicity → CNS effects → respiratory failure → vasodilatory shock.

No Enhanced Elimination

Toxin is intracellular — dialysis and haemoperfusion do not remove abrin. RRT only for renal support. Haemoperfusion not recommended.

Online Accessibility

Seeds purchasable online. Novel route of DSP. Requires toxicology + ICU + psychiatry involvement. Awareness among clinicians is critical.

Ref: Kumar et al. PMC10234767 | CRRT + Haemoperfusion case report PMC

  • toxicology
  • abrin-poisoning
  • critical-care
  • rosary-pea
  • medical-case-study
  • emergency-medicine
  • toxicology-teaching