eMedicine Specialties > Emergency Medicine > Toxicology

Plant Poisoning, Hypoglycemics: Follow-up

Author: Jennifer Coles Schecter, MD, Staff Physician, Department of Emergency Medicine, Lahey Clinic, Burlington, MA
Coauthor(s): Sage W Wiener, MD, Assistant Professor, Department of Emergency Medicine, State University of New York Downstate, Director of Medical Toxicology, Department of Emergency Medicine, Kings County Hospital Center
Contributor Information and Disclosures

Updated: Nov 10, 2009

Follow-up

Further Inpatient Care

Patients with the following conditions after ackee fruit poisoning should be admitted to the hospital:

  • Severe, persistent hypoglycemia
  • Intractable vomiting
  • Seizures
  • Altered mental status
  • Hypotension
  • Elevated liver enzyme levels or other evidence of liver damage

Deterrence/Prevention

  • Patients and their families should be educated about the risks of unripe ackee fruit ingestion.

Prognosis

  • Prognosis is good if unripe ackee fruit ingestion is promptly recognized and appropriately managed; however, deaths do occur.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to observe seizure precautions (eg, adequately control seizures and secure airway of seizing or obtunded patients)
  • Failure to aggressively monitor and treat hypoglycemia
  • Failure to consider other causes of hypoglycemia and liver failure
  • Failure to adequately assess and manage fluid and electrolyte status
  • Failure to consider diagnosis of ackee fruit ingestion
  • Failure to consider potential exposure of family members or community of exposed patient

Special Concerns

  • Pregnancy: In Jamaica, concern exists that ackee fruit ingestion may be associated with anencephaly, spina bifida, and hydrocephalus; however, teratogenic effects are not well established.
  • Pediatric: Most cases occur in children. Generally, full recovery can be expected if hypoglycemia is identified and treated early and if liver failure and metabolic acidosis do not ensue.
 


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
References
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References

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  2. US Department of Agriculture. Improve the Detection of Quality Attributes and Chemical Agents in Agricultural Commodities. Last updated November 9, 2009. Available at http://www.ars.usda.gov/research/publications/publications.htm?SEQ_NO_115=215290. Accessed November 10, 2009.

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

  4. Meda HA, Diallo B, Buchet JP, Lison D, Barennes H, Ouangre A, et al. Epidemic of fatal encephalopathy in preschool children in Burkina Faso and consumption of unripe ackee (Blighia sapida) fruit. Lancet. Feb 13 1999;353(9152):536-40. [Medline].

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  7. Billington D, Osmundsen H, Sherratt HS. The biochemical basis of Jamaican akee poisoning. N Engl J Med. Dec 23 1976;295(26):1482. [Medline].

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Further Reading

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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

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Contributor Information and Disclosures

Author

Jennifer Coles Schecter, MD, Staff Physician, Department of Emergency Medicine, Lahey Clinic, Burlington, MA
Disclosure: Nothing to disclose.

Coauthor(s)

Sage W Wiener, MD, Assistant Professor, Department of Emergency Medicine, State University of New York Downstate, Director of Medical Toxicology, Department of Emergency Medicine, Kings County Hospital Center
Sage W Wiener, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

B Zane Horowitz, MD, FACMT, Professor, Department of Emergency Medicine, Oregon Health and Sciences University; Medical Director, Oregon Poison Center; Medical Director, Alaska Poison Control System
B Zane Horowitz, MD, FACMT is a member of the following medical societies: American Academy of Clinical Toxicology and American College of Medical Toxicology
Disclosure: Nothing to disclose.

Pharmacy Editor

John T VanDeVoort, PharmD, Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals
John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.

Managing Editor

Michael Hodgman, MD, Assistant Clinical Professor of Medicine, Department of Emergency Medicine, Bassett Healthcare
Michael Hodgman, MD is a member of the following medical societies: American College of Medical Toxicology, American College of Physicians, Medical Society of the State of New York, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD, Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital
Disclosure: Nothing to disclose.

 
 
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