Hypoglycemic Plant Poisoning Workup

Updated: Feb 18, 2019
  • Author: Nathan Reisman, MD; Chief Editor: Sage W Wiener, MD  more...
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Workup

Laboratory Studies

Laboratory studies include:

  • Fingerstick glucose/rapid glucose determination to evaluate for hypoglycemia (Glucose levels as low as 3 mg/dL have been reported.) [10]
  • 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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