Lessons from a suicide attempt by intra-abdominal ricin injection





ricin, Ricinus communis, suicide attempt, multiorgan-failure, shock, ARDS


A 19-year-old woman was admitted to the emergency department 7 hours after a suicide attempt with an intra-abdominal injection of self-prepared ricin solution. In the following 6 days, she has developed multiorgan-failure, and despite all intensive care interventions—including plasma exchange, high-frequency ventilation, and continuous renal replacement therapy—she passed away. We describe in detail the chain of events and discuss shortly the known literature about this rare poisoning.

Author Biographies

Ayana Dvir, MD, MHA

Intensive Care Unit, Shamir Medical Center, Zerifin, Israel

Zahi Dagan, MD, MHA

Pediatric Department, Shamir Medical Center, Zerifin, Israel

Avi Mizrachi, MD

Intensive Care Unit, Shamir Medical Center, Zerifin, Israel

Arik Eisenkraft, MD, MHA

The Institute for Research in Military Medicine, The Faculty of Medicine, The Hebrew University of Jerusalem and the IDF Medical Corps, Jerusalem, Israel


Wang CF, Nie XJ, Chen GM, et al.: Early plasma exchange for treating ricin toxicity in children after castor bean ingestion. J Clin Apher. 2015; 30(3): 141-146.

Bradberry SM, Dickers KJ, Rice P, et al.: Ricin poisoning (review). Toxicol Rev. 2003; 22(1): 65-70.

Maman M, Yehezkelli Y: Chapter 8: Ricin: A possible, noninfectious biological weapon. In Fong IW, Alibek K (eds.): Bioterrorism and Infectious Agents: A New Dilemma for the 21st Century. New York: Springer Science + Business Media Inc., 2005: 205-216.

Berger T, Eisenkraft A, Bar-Haim E, et al.: Toxins as biological weapons for terror-characteristics, challenges and medical countermeasures: A mini-review. Disaster Mil Med. 2016; 2: 7.

Worbs S, Köhler K, Pauly D, et al.: Ricinus communis intoxications in human and veterinary medicine—A summary of real cases. Toxins (Basel). 2011; 3(10): 1332-1372.

Audi JM, Belson M, Patel M, et al.: Ricin poisoning: A comprehensive review. J Am Med Assoc. 2005; 294(18): 2342-2351.

Godal A, Fodstad O, Ingebrigtsen K, et al.: Pharmacological studies of ricin in mice and humans. Cancer Chemother Pharmacol. 1984; 13: 157-163.

Shea DA, Gottron F: Small-scale terrorist attacks using chemical and biological agents: An assessment framework and preliminary comparisons. CRS Report RL32391. 2004.



How to Cite

Dvir, MD, MHA, A., Z. Dagan, MD, MHA, A. Mizrachi, MD, and A. Eisenkraft, MD, MHA. “Lessons from a Suicide Attempt by Intra-Abdominal Ricin Injection”. American Journal of Disaster Medicine, vol. 16, no. 1, Jan. 2021, pp. 75-80, doi:10.5055/ajdm.2021.0389.



Case Studies