Hypoglycemics Plant Poisoning Workup

  • Author: Jennifer Coles Schecter, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Jan 12, 2011
 

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)
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Imaging Studies

  • 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

  • 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

  • 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

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.

Specialty Editor Board

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.

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.

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.

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.

References

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