39th International Congress of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) 21-24 May 2019, Naples, Italy

Abstract

Objective: Since the early 1980s, the Milan National Poison Control Centre (MNPCC) has implemented a surveillance and alerting system (MNPCC-SAS) to characterize hazardous exposures, identify unexpected events, support prevention and legislative acts and evaluate their impact [1]. The MNPCC-SAS recently generated an alert concerning organic nitrogen fertilizers (ONFs) containing ricin. We describe how this alert was generated and the resulting preventive actions in Italy. Methods: A review of animal cases with severe or lethal poisoning associated with ingestion of organic nitrogen fertilizers (ONFs) occurred between May 2017 and August 2018. Laboratory detection of ricin in ONF samples and in vitro toxicity assays to measure functional activity of the detected ricin. Results: In May 2017, the MNPCC was asked to provide toxicological advice for a dog that developed severe gastric effects within 6 hours following ingestion of an ONF (nitrogen 5.5%). The dog died 24 hours after exposure due to internal hemorrhage. The MNPCC-SAS immediately generated an alert since this was unexpected for this type of product. The labelled contents of the ONF was 90-100% unspecified seed cake. Subsequently, it was determined that this was castor oil bean (Ricinus communis) cake and, therefore, suspected to contain ricin. Four lethal and five severe canine poisonings due to ingestion of castor oil cake ONFs were identified by the MNPCC-SAS over the next few months and promptly notified to the Italian Ministry of Health. Laboratory analyses detected more than 69mg ricin/100 g of fertilizer. In October 2018 the Italian Ministry of Health removed these products from the market. Conclusion: Ricin is a potent phytotoxin. The oral LD50 dose in humans has been estimated to be 1-20 mg/kg [2]. It can be easily extracted and used in terrorism and bio-crime [3]. In view of this and the canine cases reported in Italy and other countries [2], ricin in ONFs should be urgently regulated by European and national legislations and subject to stringent control.