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


Hypoglycemic Plant Poisoning Treatment & Management

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

Prehospital Care

Prehospital providers are unlikely to be familiar with or recognize hypoglycemic plant poisoning, but can usually treat both seizures and hypoglycemia in the prehospital setting.

Both seizures and hypoglycemia, as well as airway compromise, should be treated according to local protocols.

Intravenous or intraosseous access should be obtained and administration of dextrose, benzodiazepines (if needed to control seizures), and dextrose-containing intravenous fluid, as necessary, should be provided.

Intranasal benzodiazepines may be useful in the actively seizing patient in whom intravenous or intraosseous access is difficult or unsuccessful.[7, 8]


Emergency Department Care

ED management of ackee poisoning is mainly supportive.

Obtain a rapid fingerstick glucose and initiate early glucose replacement with D50W boluses (D25W boluses in young children and D10W in neonates) and continuous infusions of 10% dextrose, as needed.

Airway assessment and endotracheal intubation, if necessary, should be performed.

Activated charcoal may be administered once the airway is secured.

Electrolyte status should be assessed.

Antiemetics such as metoclopramide, ondansetron, or granisetron may be administered for profuse vomiting.

Seizure precautions should be followed; treat seizures with benzodiazepines and dextrose.

Theoretically, L-carnitine could be beneficial similar to its effect in valproic acid toxicity.

Methylene blue has a theoretical benefit in ackee fruit poisoning, but animal studies do not show any benefit over early glucose administration alone.[9] There are no data in humans.

There are no data on the use of glucagon or octreotide in the treatment of hypoglycemia associated with hypoglycemic plant poisoning.



The local poison center should be contacted.

Consultation with a toxicologist may be helpful.

Contact public health authorities for suspected outbreaks.

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.