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Hypoglycemic Plant Poisoning Workup

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

Laboratory Studies

See the list below:

  • 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)
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Imaging Studies

See the list below:

  • Nonenhanced head CT may be performed to exclude intracranial pathology as a cause for altered mental status, seizures, or focal neurologic deficits.
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Other Tests

See the list below:

  • 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).
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Procedures

See the list below:

  • 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.
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Contributor Information and Disclosures
Author

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.

Coauthor(s)

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.

Acknowledgements

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.

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