Medscape is available in 5 Language Editions – Choose your Edition here.


Hypoglycemic Plant Poisoning Medication

  • Author: Nathan Reisman, MD; Chief Editor: Asim Tarabar, MD  more...
Updated: Apr 28, 2015

Medication Summary

Supportive treatment with glucose, fluid, and electrolyte replacement is the mainstay of therapy. Antiemetics are used to control vomiting, and benzodiazepines are used to control seizures. Supplemental carnitine may be considered, although it has not been studied in this context.


GI decontaminant

Class Summary

These agents are used to adsorb toxin in the GI tract, limiting systemic adsorption.

Activated charcoal (Liqui-Char)


Emergency treatment in poisoning caused by drugs and chemicals. Network of pores present in activated charcoal adsorbs 100-1000 mg of drug per gram of charcoal. Does not dissolve in water.

For maximum effect, administer as soon as possible after ingesting poison.



Class Summary

Dextrose is used to reverse hypoglycemia. Carnitine, an amino acid derivative, is synthesized from methionine and lysine and is required in energy metabolism. It can promote excretion of excess fatty acids in patients with defects in fatty acid metabolism or specific organic acidopathies that bioaccumulate acyl CoA esters.

Dextrose (D-glucose)


Monosaccharide absorbed from the intestine and then distributed, stored, and used by the tissues.

Parenterally injected dextrose is used in patients unable to sustain adequate oral intake. Direct oral absorption results in a rapid increase in blood glucose concentrations.

Dextrose is effective in small doses, and no evidence exists that it may cause toxicity. Concentrated dextrose infusions provide higher amounts of glucose and increased caloric intake in a small volume of fluid.

Levocarnitine (Carnitor)


May facilitate transport of fatty acids into mitochondria. Carnitine has been used successfully in treatment of chronic valproate toxicity associated with hyperammonemia. Chronic valproate toxicity is thought to inhibit carnitine-dependent transfer of fatty acids from cytosol into mitochondria for beta-oxidation.


Somatostatin analogs

Class Summary

These agents are used to reduce blood levels of GH glucagon and VIP peptides.

Octreotide (Sandostatin)


Acts primarily on somatostatin receptor subtypes II and V. Inhibits GH secretion and has a multitude of other endocrine and nonendocrine effects, including inhibition of glucagon, VIP, and GI peptides. Inhibits insulin release.


Antianxiety Agent

Class Summary

Benzodiazepines may be used to treat seizures.

Lorazepam (Ativan)


Sedative hypnotic with short onset of effects and relatively long half-life.

By increasing the action of gamma-aminobutyric acid (GABA), which is a major inhibitory neurotransmitter in the brain, may depress all levels of CNS, including limbic and reticular formation.

Important to monitor patient's blood pressure after administering dose. Adjust as necessary.



Class Summary

Antiemetics may be used to control severe and persistent vomiting. Agents in this class may also prevent nausea and vomiting associated with emetogenic cancer chemotherapy

Ondansetron (Zofran)


Selective 5-HT3-receptor antagonist that blocks serotonin both peripherally and centrally. Prevents nausea and vomiting associated with emetogenic cancer chemotherapy (eg, high-dose cisplatin) and complete body radiotherapy.

Metoclopramide (Reglan)


Stimulates motility of the upper GI tract. Dopamine antagonist that stimulates acetylcholine release in the myenteric plexus. Acts centrally on chemoreceptor triggers in the floor of the fourth ventricle, providing important antiemetic activity.

Granisetron (Kytril)


At chemoreceptor trigger zone, blocks serotonin peripherally on vagal nerve terminals and centrally.

Contributor Information and Disclosures

Nathan Reisman, MD Clinical Assistant Instructor, Department of Emergency Medicine, Kings County Hospital Center, SUNY Downstate Medical Center

Nathan Reisman, MD is a member of the following medical societies: Emergency Medicine Residents' Association, Society for Simulation in Healthcare

Disclosure: Nothing to disclose.


Sage W Wiener, MD Assistant Professor, Department of Emergency Medicine, State University of New York Downstate Medical Center; 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, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and 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.

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.

Additional Contributors

B Zane Horowitz, MD, FACMT Professor, Department of Emergency Medicine, Oregon Health and Sciences University School of Medicine; 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 College of Medical Toxicology

Disclosure: Nothing to disclose.


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.

Jennifer Coles Schecter, MD Resident Physician, Department of Emergency Medicine, Lahey Clinic, Burlington, MA

Disclosure: Nothing to disclose.

  1. Barceloux DG. Akee fruit and Jamaican vomiting sickness (Blighia sapida Köenig). Dis Mon. 2009 Jun. 55(6):318-26. [Medline].

  2. Whitaker TB, Saltsman JJ, Ware GM, Slate AB. Evaluating the performance of sampling plans to detect hypoglycin A in ackee fruit shipments imported into the United States. J AOAC Int. 2007 Jul-Aug. 90(4):1060-72. [Medline].

  3. US Department of Agriculture. Improve the Detection of Quality Attributes and Chemical Agents in Agricultural Commodities. Last updated November 9, 2009. Available at Accessed: November 10, 2009.

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

  5. 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. 1999 Feb 13. 353(9152):536-40. [Medline].

  6. Joskow R, Belson M, Vesper H, Backer L, Rubin C. Ackee fruit poisoning: an outbreak investigation in Haiti 2000-2001, and review of the literature. Clin Toxicol (Phila). 2006. 44(3):267-73. [Medline].

  7. Humphries LK, Eiland LS. Treatment of acute seizures: is intranasal midazolam a viable option?. J Pediatr Pharmacol Ther. 2013 Apr. 18(2):79-87. [Medline]. [Full Text].

  8. Holsti M, Sill BL, Firth SD, Filloux FM, Joyce SM, Furnival RA. Prehospital intranasal midazolam for the treatment of pediatric seizures. Pediatr Emerg Care. 2007 Mar. 23(3):148-53. [Medline].

  9. Barennes H, Valea I, Boudat AM, Idle JR, Nagot N. Early glucose and methylene blue are effective against unripe ackee apple (Blighia sapida) poisoning in mice. Food Chem Toxicol. 2004 May. 42(5):809-15. [Medline].

  10. 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].

  11. Barennes H, Valea I, Boudat AM, Idle JR, Nagot N. Early glucose and methylene blue are effective against unripe ackee apple (Blighia sapida) poisoning in mice. Food Chem Toxicol. 2004 May. 42(5):809-15. [Medline].

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

  13. Bressler R. Editorial: The unripe akee - forbidden fruit. N Engl J Med. 1976 Aug 26. 295(9):500-1. [Medline].

  14. Brun T. Pesticide toxicity or hypoglycine A poisoning (Ivory Coast, 1984)?. Lancet. 1988 Apr 23. 1(8591):934. [Medline].

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

  16. Escoffery CT, Shirley SE. Fatal poisoning in Jamaica: a coroner's autopsy study from the University Hospital of the West Indies. Med Sci Law. 2004 Apr. 44(2):116-20. [Medline].

  17. Hernandez-Galicia E, Aguilar-Contreras A, Aguilar-Santamaria L, Roman-Ramos R, Chavez-Miranda AA, Garcia-Vega LM. Studies on hypoglycemic activity of Mexican medicinal plants. Proc West Pharmacol Soc. 2002. 45:118-24. [Medline].

  18. Kean EA. Selective inhibition of acyl-CoA dehydrogenases by a metabolite of hypoglycin. Biochim Biophys Acta. 1976 Jan 23. 422(1):8-14. [Medline].

  19. Khanna P, Jain SC, Panagariya A, Dixit VP. Hypoglycemic activity of polypeptide-p from a plant source. J Nat Prod. 1981 Nov-Dec. 44(6):648-55. [Medline].

  20. Mentreddy S, Mohamed A, Rimando A. Medicinal Plants with Hypoglycemic/ant-Hyperglycemic Properties: a Review. USDA: Agricultural Research Services. August 2005. Association for the Advancement of Industrial Crops Conference: 20:341-353.

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

  22. Mukherjee PK, Maiti K, Mukherjee K, Houghton PJ. Leads from Indian medicinal plants with hypoglycemic potentials. J Ethnopharmacol. 2006 Jun 15. 106(1):1-28. [Medline].

  23. Nicola WG, Ibrahim KM, Mikhail TH, Girgis RB, Khadr ME. Role of the hypoglycemic plant extract cleome droserifolia in improving glucose and lipid metabolism and its relation to insulin resistance in fatty liver. Boll Chim Farm. 1996 Oct. 135(9):507-17. [Medline].

  24. Persuad TVN. Foetal abnormalities caused by the active principle of the fruit of Blighia sapida (Akee). West Indian Med J. 1967. 16:193-97.

  25. Quere M, Ogouassangni A, Bokossa A, Perra A, Van Damme W. Methylene blue and fatal encephalopathy from ackee fruit poisoning. Lancet. 1999 May 8. 353(9164):1623. [Medline].

  26. Saxena A, Vikram NK. Role of selected Indian plants in management of type 2 diabetes: a review. J Altern Complement Med. 2004 Apr. 10(2):369-78. [Medline].

  27. Sherratt HS, Turnbull DM. Methylene blue and fatal encephalopathy from ackee fruit poisoning. Lancet. 1999 May 8. 353(9164):1623-4. [Medline].

  28. 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].

All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.