Ackee Fruit Toxicity Follow-up

  • Author: Dave A Holson, MD, MBBS, MPH; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Aug 19, 2011
 

Further Inpatient Care

Patients who have consumed ackee fruit and have the following conditions should be admitted to the hospital:

  • Severe and persistent hypoglycemia
  • Intractable vomiting
  • Seizures
  • Altered mental status
  • Hypotension
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Inpatient & Outpatient Medications

  • Administer dextrose solution to maintain normal blood glucose levels.
  • Decontamination with activated charcoal is contraindicated in patients with active emesis and risk of seizure.
  • Administer antiemetics to control vomiting.
  • Administer thiamine to the patient who is alcoholic or malnourished.
  • Administer benzodiazepines to control seizures.
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Deterrence/Prevention

  • Avoid eating unripe ackee fruit.
  • Avoid eating ackee fruit that has been forcibly opened.
  • Discard water in which ackee fruit is boiled.
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Complications

  • Profound hypoglycemia
  • Acidosis
  • Hypovolemia
  • Seizures
  • Coma
  • Death
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Prognosis

  • Before treatments were developed, the mortality rate was 80%.
  • Most patients have a full recovery.
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Patient Education

  • Educate patients about the danger of eating unripe or forcibly opened ackee fruit.
  • Instruct patients to discard the water in which the fruit was prepared.
  • Inform patients about the symptoms and signs of ackee fruit poisoning and the importance of immediately seeking medical attention.
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Contributor Information and Disclosures
Author

Dave A Holson, MD, MBBS, MPH  Assistant Professor of Emergency Medicine, Mount Sinai School of Medicine; Director, Department of Emergency Medicine, Queens Hospital Center

Dave A Holson, MD, MBBS, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, National Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael E Mullins  MD, Assistant Professor, Division of Emergency Medicine, Washington University School of Medicine, Emergency Department, Barnes Jewish Hospital, St Louis, Missouri

Michael E Mullins is a member of the following medical societies: American Academy of Clinical Toxicology and American College of Emergency Physicians

Disclosure: Johnson & Johnson stock ownership None; Savient Pharmaceuticals stock ownership None

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Jeffrey R Tucker, MD  Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut and Connecticut Children's Medical Center

Disclosure: Merck Salary Employment

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Timothy E Corden, MD  Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Glendon C Henry, MD, and Sekuleo Gathers, MD, to the original writing and development of this article.

References

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  2. Joskow R, Belson M, Vesper H, et al. Ackee fruit poisoning: an outbreak investigation in Haiti 2000-2001 and review of the literature. Clin Toxicol (Phila). 2006;44 (3):267-73.

  3. Moya J. Ackee (Blighia sapida) poisoning in the Nothern Province, Haiti, 2001. Epidemiol Bull. June 2006;22 (2):8-9.

  4. Gaillard Y, Carlier J, Berscht M, et al. Fatal intoxication due to ackee (Blighia sapida) in Suriname and French Guyana. GC-MS detection and quantification of hypoglycin-A. Forensic Sci Int. Mar 20 2011;206(1-3):e103-7. [Medline].

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  9. Barennes, H, Valea, I, Boudat AM, et al. Early glucose and methylene blue are effective against unripe ackee apple poisoning in mice. Food and Chemical Toxicology. 2004;42(5):809-815. [Medline].

  10. Bressler R, Corredor C, Brendel K. Hypoglycin and hypoglycin-like compounds. Pharmacol Rev. Jun 1969;21(2):105-30. [Medline].

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  12. Eddleston M, Persson H. Acute plant poisoning and antitoxin antibodies. J Toxicol Clin Toxicol. 2003;41(3):309-15. [Medline].

  13. Kean EA. Commentary on a review on the mechanism of ackee-induced vomiting sickness. West Indian Med J. Sep 1988;37(3):139-42. [Medline].

  14. Larson J, Vender R, Camuto P. Cholestatic jaundice due to ackee fruit poisoning. Am J Gastroenterol. Sep 1994;89(9):1577-8. [Medline].

  15. McTague JA, Forney R Jr. Jamaican vomiting sickness in Toledo, Ohio. Ann Emerg Med. May 1994;23(5):1116-8. [Medline].

  16. Mills J, Melville GN, Bennett C, et al. Effect of hypoglycin A on insulin release. Biochem Pharmacol. Feb 15 1987;36(4):495-7. [Medline].

  17. Tanaka K, Kean EA, Johnson B. Jamaican vomiting sickness. Biochemical investigation of two cases. N Engl J Med. Aug 26 1976;295(9):461-7. [Medline].

 
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Freshly picked Ackee fruit
Black seeds surrounded by a thick, oily, yellow aril (edible portion).
 
 
 
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