eMedicine Specialties > Emergency Medicine > Toxicology
Plant Poisoning, Hypoglycemics: Differential Diagnoses & Workup
Updated: Nov 10, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Differential Diagnoses
Other Problems to Be Considered
Fatty liver of pregnancy
Chronic valproic acid use
Chronic nucleoside analog (eg, didanosine [DDL], zidovudine [AZT]) use
Ingestion of outdated tetracycline
Ingestion of oral hypoglycemics (sulfonylureas) (eg, metformin, phenformin, chlorpropamide)
Quinine ingestion
Disopyramide ingestion
Pentamidine ingestion
Streptozotocin exposure
Vacor exposure
Herbal product and tea consumption (eg, pennyroyal oil, margosa oil, comfrey, chaparral, germander, groundsel or senecio, Jin Bu Huan, and Syo-saiko-to)
Workup
Laboratory Studies
- Fingerstick glucose/rapid glucose determination to evaluate for hypoglycemia (Glucose levels as low as 3 mg/dL have been reported.)
- Chemistry panel (sodium, potassium, chloride, carbon dioxide, blood urea nitrogen, and creatinine levels) to evaluate for acidosis, hypokalemia, and electrolyte disturbance as a cause for vomiting
- Serum ketone levels (if present, suggest other cause of hypoglycemia)
- Urinalysis in ackee poisoning shows acidosis and no ketosis.
- Serum ammonia level (Hyperammonemia is characteristic.)
- Liver transaminase level and prothrombin time (PT)/activated partial thromboplastin time (aPTT) to assess extent of liver toxicity
- Arterial pH to evaluate acid/base status
- Serum lactate levels (may be elevated)
- Cerebrospinal fluid (generally reveals low glucose level)
Imaging Studies
- Nonenhanced head CT may be performed to exclude intracranial pathology as a cause for altered mental status, seizures, or focal neurologic deficits.
Other Tests
- Gas chromatography of urine: Excess excretion of medium-chain dicarboxylic acids, such as 2-ethylmalonic, 2-methylsuccinic, and glutaric acid, is a distinctive finding in this illness.
- Presence of positive serum or urine level of hypoglycin A or its metabolite methylenecyclopropyl acetic acid (MCPA) indicates exposure to ackee fruit.
- Autopsy findings include massive steatosis of the liver (comparable with Reye syndrome).
Procedures
- Endotracheal intubation: A secure airway may be necessary for patients presenting with seizures or coma.
- Intravenous access: Intravenous access may be needed to administer glucose-containing solutions, intravenous antiemetics and anticonvulsants, and volume resuscitation.
More on Plant Poisoning, Hypoglycemics |
| Overview: Plant Poisoning, Hypoglycemics |
 Differential Diagnoses & Workup: Plant Poisoning, Hypoglycemics |
| Treatment & Medication: Plant Poisoning, Hypoglycemics |
| Follow-up: Plant Poisoning, Hypoglycemics |
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References
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Further Reading
Keywords
ackee fruit poisoning, hypoglycemia, ackee fruit, Jamaican vomiting sickness, hypoglycin, hypoglycin A, vomiting, Blighia sapida, B sapida, gourd bitter melon, herb fenugreek, pomegranate fruit, climbing ivy gourd, mamijava, Asian ginseng, American ginseng, Siberian ginseng, ginseng, Momordica charantia, M charantia, Trigonella foenum-graecum, T foenum-graecum, Coccinia indica, C indica, Enicostemma littorale, E littorale, Panax ginseng, P ginseng, Panax quinquefolius, P quinquefolius, Eleutherococcus senticosus, E senticosus
