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Ackee Fruit Toxicity Workup

  • Author: Dave A Holson, MD, MBBS, MPH; Chief Editor: Timothy E Corden, MD  more...
 
Updated: Apr 23, 2015
 

Laboratory Studies

See the list below:

  • In patients with suspected ackee fruit poisoning, immediately order a fingerstick glucose test.
    • Do not wait for the serum glucose result.
    • Profound hypoglycemia with blood glucose levels as low as 3 mg/dL has been documented.
  • Obtain a serum chemical test to exclude electrolyte abnormalities as a consequence of the intractable vomiting. Elevated ammonia levels have also been reported.
  • Liver function tests demonstrate increased hepatic transaminases.
  • Obtain a urinalysis. In ackee fruit poisoning, results show acidosis but no ketosis.
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Imaging Studies

See the list below:

  • Nonenhanced head CT scanning may be indicated for the exclusion of structural intracranial pathology in patients with altered mental status or new-onset seizures.
  • Patients with hypoglycemia may present with a focal neurologic deficit. In other patients, head CT scan findings should be normal.
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Histologic Findings

See the list below:

  • Liver biopsy reveals depleted glycogen stores.
  • Postmortem examination reveals the absence of liver glycogen and the fatty metamorphosis of the liver, kidney, and other organs.
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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, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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 School of Medicine, Connecticut Children's Medical Center

Disclosure: Received salary from Merck for employment.

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, Wisconsin Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Michael E Mullins, MD Assistant Professor, Division of Emergency Medicine, Washington University in St Louis School of Medicine; Attending Physician, Emergency Department, Barnes-Jewish Hospital

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

Disclosure: Received stock ownership from Johnson & Johnson for none; Received stock ownership from Savient Pharmaceuticals for none.

Acknowledgements

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
  1. Sharma S, Yacavone MM, Cao X, Samuda PM, Cade J, Cruickshank K. Nutritional composition of commonly consumed composite dishes for Afro-Caribbeans (mainly Jamaicans) in the United Kingdom. Int J Food Sci Nutr. 2009 Apr 1. 1-11. [Medline].

  2. Emanuel MA, Gutierrez-Orozco F, Yahia EM, Benkeblia N. Assessment and profiling of the fatty acids in two ackee fruit (Blighia sapida Köenig) varieties during different ripening stages. J Sci Food Agric. 2013 Mar 15. 93(4):722-6. [Medline].

  3. Schwartzbord JR, Emmanuel E, Brown DL. Haiti's food and drinking water: a review of toxicological health risks. Clin Toxicol (Phila). 2013 Nov. 51(9):828-33. [Medline].

  4. 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.

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

  6. 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. 2011 Mar 20. 206(1-3):e103-7. [Medline].

  7. American Medical Association; American Nurses Association-American Nurses Foundation; Centers for Disease Control and Prevention; Center for Food Safety and Applied Nutrition, Food and Drug Administration; Food Safety and Inspection Service, US Departm... Diagnosis and management of foodborne illnesses: a primer for physicians and other health care professionals. MMWR Recomm Rep. 2004 Apr 16. 53:1-33. [Medline].

  8. Vlasselaers D, Milants I, Desmet L, et al. Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study. Lancet. 2009 Feb 14. 373(9663):547-56. [Medline].

  9. Addae JI, Melville GN. A re-examination of the mechanism of ackee-induced vomiting sickness. West Indian Med J. 1988 Mar. 37(1):6-8. [Medline].

  10. [Guideline] Barceloux DG. Akee fruit and Jamaican vomiting sickness (Blighia sapida Koenig). Dis Mon. Jun 2001. 55 (6):318-26.

  11. 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].

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

  13. CDC. Toxic hypoglycemic syndrome--Jamaica, 1989-1991. MMWR Morb Mortal Wkly Rep. 1992 Jan 31. 41(4):53-5. [Medline].

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

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

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

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

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

  19. Tanaka K, Kean EA, Johnson B. Jamaican vomiting sickness. Biochemical investigation of two cases. N Engl J Med. 1976 Aug 26. 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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