History

Typically, ackee fruit poisoning causes epidemics, with multiple children becoming ill. The patient may provide a history of ingesting unripe ackee fruit or water in which unripe ackee had been cooked. More than one family member may be ill.

Sudden onset of vomiting begins 2-6 hours after ingestion with generalized epigastric discomfort. However, symptoms may appear within minutes.

After a period of prostration lasting up to 18 hours, a second bout of vomiting may occur. Unless treatment is given, this episode can progress to seizures, coma, and death. In severe poisoning, death usually occurs within 12 hours after ingestion.

Physical Examination

Nausea and vomiting occur in 75% of patients; severe vomiting may be followed by a quiescent phase, followed by recurrent vomiting. Diaphoresis and pallor may be observed. Tachypnea, tachycardia, and hypotension due to dehydration may be noted. Weakness and paresthesias may be present. Seizures, generalized tonic-clonic, occur in 24% of patients. Drowsiness and coma occurs in 25% of patients. Mortality in severe, untreated cases can reach 80%.

Differential Diagnoses

Isenberg SL, Carter MD, Hayes SR, Graham LA, Johnson D, Mathews TP, et al. Quantification of Toxins in Soapberry (Sapindaceae) Arils: Hypoglycin A and Methylenecyclopropylglycine. J Agric Food Chem. 2016 Jul 13. 64 (27):5607-13. [QxMD MEDLINE Link]. [Full Text].
Adelia C. Bovell-Benjamin, Jerry Roberts. Naturally Occurring Toxicants: Presence in Selected Commonly Consumed Fruits. https://www.sciencedirect.com/. Available at https://www.sciencedirect.com/science/article/pii/B978012800605400013X. Accessed: February 12, 2023.
Barceloux DG. Akee fruit and Jamaican vomiting sickness (Blighia sapida Köenig). Dis Mon. 2009 Jun. 55(6):318-26. [QxMD MEDLINE Link].
Surmaitis R, Hamilton RJ. Ackee Fruit Toxicity. 2022 Jan. [QxMD MEDLINE Link]. [Full Text].
Ajayi AM, Ayodele EO, Ben-Azu B, Aderibigbe AO, Umukoro S. Evaluation of neurotoxicity and hepatotoxicity effects of acute and sub-acute oral administration of unripe ackee (Blighia sapida) fruit extract. Toxicol Rep. 2019. 6:656-665. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link].
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: February 12, 2023.
CDC. Toxic hypoglycemic syndrome--Jamaica, 1989-1991. MMWR Morb Mortal Wkly Rep. 1992 Jan 31. 41(4):53-5. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Popa SL, Chiarioni G, David L, Golea GI, Dumitrascu DL. Rare causes of emesis. Med Pharm Rep. 2020 Apr. 93 (2):127-132. [QxMD MEDLINE Link]. [Full Text].
Pitkin F and Randall S. Laboratory Patterns in Hypoglycin A Toxicity. Archives of Clinical and Biomedical Research. 10 April 2017. 1(3):76-84. [Full Text].
Humphries LK, Eiland LS. Treatment of acute seizures: is intranasal midazolam a viable option?. J Pediatr Pharmacol Ther. 2013 Apr. 18(2):79-87. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].

Media Gallery

of 0

Author

Nathan Reisman, MD Clinical Assistant Professor, Department of Emergency Medicine, SUNY Downstate Medical Center

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

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.