iCliniq Logo
HomeHealth articlesGeneral Medicinefood poisoning
First aid and Emergencies

Ackee Poisoning - Symptoms, Diagnosis, and Treatment

Verified data
0

4 min read

Share

Outline

Ackee poisoning is a disorder caused by consuming unripe ackee fruit. Read the article below to understand the symptoms.

Written byDr. Preetha. J

Medically reviewed byDr. Sugreev Singh

Published At March 19, 2022
Reviewed AtApril 30, 2024

Introduction:

Several plant species may produce toxic substances as a part of the plant's defense mechanism against predators. People consume ackee for various conditions, but no proper scientific evidence exists for using these products. Therefore, these products have been banned in the United States for three decades.

The ackee fruit contains a large black seed and a fleshy yellow aril. The yellow aril is the edible portion of the fruit. When unripe, the edible portion contains high levels of the toxin hypoglycin. When the fruit ripens, the hypoglycin levels drop to a safer level for human consumption. The unripe ackee fruit is very dangerous and can cause poisoning.

Differentiating the ripe from the unripe ackee fruit is necessary to prevent potential side effects. Ripe ackee fruit is yellow-red to red and has a wide-open appearance with visible seeds. The unripe fruit is green to yellow, and the seeds are not visible. Even cooking an unripe fruit will not reduce its potential for toxicity.

Risk factors for ackee fruit toxicity include:

  • Eating an unripe ackee.

  • Purchasing tampered ackee.

  • Consuming the water used to cook unripe ackee.

What Is Ackee Poisoning?

Hypoglycin A is a toxin found in the ackee fruit that can cause acute toxicity. It is also called Jamaican vomiting sickness or toxic hypoglycemic syndrome. The fruit grows in the ackee plant, which is found in West Africa, southern Florida, the Caribbean, and Central America. Many of these plants are a source of food in many countries.

Ripe ackee fruit (Blighia sapida) is eaten as food and is considered a dietary staple (like cereal grains and tuber) in Jamaica. However, toxicity occurs only with the ingestion of unripe ackee fruit. The seeds are also toxic and should not be ingested.

The ripe ackee fruits are edible, but the unripe fruits are toxic due to hypoglycin A and B. Consuming unripe fruits can cause severe hypoglycemia, often accompanied by convulsions and death.

What Are the Causes and Risk Factors of Ackee Poisoning?

  • Ackee Fruit Composition: The ackee fruit develops into three parts: a large black seed and a fleshy yellow aril in each section. The aril is the part that people eat. Initially, the aril contains high levels of the toxin hypoglycin.

  • As the ackee fruit ripens, the levels of hypoglycin decrease to safe levels for human consumption. Toxicity only arises when unripe ackee fruit is eaten.

  • Differentiating Ripe and Unripe Fruit: It is important to distinguish between ripe and unripe ackee fruit to avoid health risks.

    • Ripe ackee fruit is yellow-red to red and looks wide open, with the seeds easily visible.

    • Unripe fruit appears green to yellow, and looks closed, making it hard to see the seeds.

  • Cooking unripe ackee fruit does not make it safe to eat. The toxic seeds remain harmful even after cooking.

  • Risk Factors: Factors that increase the risk of ackee fruit toxicity include consuming unripe ackee, buying tampered ackee, or reusing water used to cook unripe ackee.

What Is the Pathophysiology of Ackee Poisoning?

The ackee fruit contains hypoglycin A, and hypoglycin B. Hypoglycin A is the main toxin linked to Jamaican vomiting sickness. Although its exact mechanism is unclear, hypoglycemia likely occurs due to the inhibition of gluconeogenesis. Metabolizing hypoglycin also creates a harmful substance called methylene cyclopropyl acetic acid (MCPA-CoA), which blocks the breakdown of long-chain fatty acids, leading to a depletion of glycogen stores. Predicting symptoms after ingestion is challenging because the minimum toxic dose is unknown. Hypoglycin may be hepatoxic, with liver pathology resembling a Reyes Syndrome-like pattern. Chronic ackee fruit ingestion has been reported to cause cholestatic jaundice among adults.

What Are the Symptoms of Ackee Poisoning?

The symptoms of poisoning from consumption of unripe ackee and roasted ackee seeds can manifest within six to 48 hours and include gastrointestinal distress, hypoglycemia, and CNS (central nervous system) depression.

The common symptoms may include:

  • Cholestatic jaundice.

  • Vomiting.

  • Hypoglycemia.

  • Convulsions.

  • Coma.

  • Potentially death.

It may take about six to 48 hours for the onset of symptoms after ingesting the unripened fruit. A remission period may be followed by symptoms like lethargy, hypothermia, hypotonia, which might progress to convulsions and coma.

If this condition is left untreated as soon as possible, it can be life-threatening. Death is more commonly seen in children than in adults. Death can occur in an average of 12.5 hours.

The other symptoms in a few cases, the other symptoms may include tonic-clonic convulsions, seizures, and fatty degeneration of the liver. Other symptoms, like fever or diarrhea will not occur. It is not safe to give unripe ackee fruit to children, or pregnant and breastfeeding women, as the unripe ackee fruit contains higher concentrations of hypoglycin A than ripe ackee fruit.

What Is the Differential Diagnosis of Ackee Poisoning?

The differential diagnosis of ackee poisoning may include:

  • Acute gastritis.

  • Meningitis.

  • Influenza.

  • Hypoglycemia

  • Acute poisoning in general.

  • Aspirin poisoning.

  • Intestinal obstruction.

  • Sulfonylurea poisoning.

How to Treat Ackee Poisoning?

There is no antidote for hypoglycin A, so the treatment is usually primary management. Patients are monitored carefully for hypoglycemia and should be infused with Dextrose. Intravenous fluids should be given to avoid dehydration, and antiemetics should be taken to relieve symptoms like vomiting. Vomiting and dehydration can lead to electrolyte imbalance, which should be replaced.

Medications:

  • Benzodiazepines may be used to treat seizures.

  • GI (gastrointestinal) decontaminates with activated charcoal and gastric lavage when there is potential toxicity and if the patient is rushed to the hospital within a few hours of ingestion. However, there is no evidence that GI decontamination can improve patient outcomes. Riboflavin and glycine are included in the treatment to antagonize hypoglycin A.

  • Methylene blue is used for potentially fatal encephalopathy.

  • Patients with symptoms like seizures, hypoglycemia, metabolic acidosis, poor perfusion, or altered mental status will require admission to an intensive care unit (ICU).

  • Education regarding the health hazards of eating unripe ackee fruits may decrease the future incidence of the disease.

Healthcare providers working in the emergency department should be aware of the potential toxicity of unripe ackee fruit for early diagnosis and timely management. The public should be educated regarding the proper preparation of the ackee fruit to reduce the toxicity rates in areas where it is endemic.

The nursing staff should assess the patients exposed to the casualties and immediately communicate with the clinical emergency department staff to consult the toxicologists. Once the disease is diagnosed, the interprofessional clinicians and nurses must communicate to ensure appropriate support is rendered soon. The nurses must monitor the patient carefully for any changes in the vital signs and immediately report to the clinical team to initiate adjustments in care.

What Are the Complications of Ackee Poisoning?

The complications of ackee poisoning may include hypoglycemia, coma, and eventually death. There can also be acidosis, hypovolemia, and seizures.

Conclusion:

The best way to prevent ackee poisoning is to avoid consuming unripe ackee fruit and water in which the ackee fruit has been boiled. Nurses and clinicians, including physician assistants, nurse practitioners, and physicians, must educate patients about the dangers of consuming ackee fruit. Ensuring children and adults are not exposed to unripe ackee fruit is the safest approach to preventing morbidity and mortality.

Listen to related tracks in our music library

Frequently Asked Questions

There is no antidote for ackee poisoning. The poisoning can be managed by supportive treatment. Intravenous administration of fluids should be given to avoid dehydration, and drugs to control vomiting should be given. The toxin Hypoglycin A present in the fruit can reduce the blood sugar level, causing hypoglycemia. Hence, patients are advised to consume any drink with sugar on the way to the hospital.
The edible portion of the fruit is called aril and is safe to consume. The black seeds and the red outer skin of the fruit are poisonous. Currently, there is not enough information about the appropriate dosage of ackee. The dosage depends on various factors, such as the consumer’s age, health, and other conditions. Natural products are not always safe, and it is recommended to follow the instructions on the label or consult a physician before consuming.
Ackee is a fruit that is found in West Africa and is the national fruit of Jamaica. Ackee is believed to have medicinal effects and is used in the treatment of colds, fever, edema (water retention), and epilepsy (a disorder in which the activity of nerve cells is affected), but more studies are required to prove this. The ripe fruit is a staple food in Jamaica. Ackee is commonly cooked with codfish, onions, and tomatoes and served with rice or mixed in soups and curries. 
Though the consumption of ripe fruit is safe, consuming unripe fruit can be unsafe. Gastrointestinal (the digestive tract from the mouth to the anus) symptoms develop first within 6 to 48 hours after consuming the unripe fruit. The toxicity is dependent on dosage, and in severe cases, there can be seizures (uncontrolled electrical activity in the brain), hypothermia (low body temperature), coma, and death within 48 hours. In case the person is recovering, recovery occurs within one week of consumption.
The ripe fruit is safe to eat and is consumed in African countries. The unripe fruit is highly unsafe, even if it is cooked. The water used to cook the unripe fruit can also turn poisonous. The black seeds and the red lining from each section should be removed, and the flesh should be washed and drained thoroughly before cooking. The edible portion is boiled till it turns from cream to yellow and should be soft to the touch. Canned ackee needs to be boiled.
The unripe ackee fruit is poisonous. The color of the unripe fruit ranges from green to yellow and appears closed. The seeds cannot be seen easily. The unripe fruit is unsafe even if cooked. The pods in the ripe fruit are bright red and burst open easily to reveal the inner edible fruit. The Jamaicans describe the appearance of the ripe fruit as appearing to be ‘yawning’ or ‘smiling’ when they open naturally on the tree. 
The ackee fruit, when cooked and consumed properly, is rich in Vitamin A, Vitamin C, and dietary fiber. It also has other health benefits, but its medicinal values need more research. Consumption of unripe fruit causes the release of the toxin Hypoglycin from the fruit, which affects the liver. Low blood sugar levels, convulsions (a condition in which muscles contract and relax quickly with involuntary shaking of the body), and death can also occur.
Since children are more vulnerable to ackee toxicity than adults, unripe ackee should not be given to children. It is also advisable to refrain from eating ackee fruit during pregnancy and while breastfeeding. It is not scientifically proven whether ackee is safe for babies and children; hence, a pediatrician (child specialist) should be consulted before giving even ripe ackee to babies and children. 
A fruit called ackee which is exclusively found in West Africa and consumed as a staple food by Jamaicans contains black seeds, which can be poisonous. The unripe fruit, along with the black seeds and the outer red skin, is poisonous. Apple seeds are also black and contain amygdalin which releases cyanide when in contact with the digestive enzymes of humans. If eaten in small quantities, it does not cause harm, but it is safe to spit out while eating.
Ackee is a bland fruit and imbibes the flavors of the ingredients it is cooked with. Ackee is often cooked with saltfish and is the staple food of Jamaicans. The combination of ackee and saltfish tastes like scrambled eggs. Ackee has a mild nutty flavor. The nutty flavor of ackee blends with the saltiness of saltfish and gives a good taste.
The matured ackee fruit contains three sections, with each section comprising a large black seed and a fleshy yellow part called an aril. The aril is the portion of the fruit that can be consumed, but it has a toxin called hypoglycin. The level of hypoglycin is more in unripe fruit, and the toxicity decreases when the fruit ripens, making it safe for human consumption. The seeds and the outer skin are not edible and are poisonous. The unripe fruit is toxic even if cooked.
The edible fleshy portion of a ripe ackee is called an aril. Ackee can be consumed when the fruit ripens. The unripe fruit, black seeds, and outer skin are poisonous. The color of the unripe fruit ranges from green to yellow and appears closed. The seeds cannot be viewed easily. The unripe fruit is unsafe even if cooked. The pods in the ripe fruit are bright red and burst open easily to reveal the inner edible fruit. The ripe fruit is washed, drained, and cooked with other ingredients like meat or fish.
Cyanide is not present in ackee fruit, but it contains a toxin called hypoglycin which is more in unripe fruit. Consumption of unripe fruit can cause intense vomiting, and blood sugar levels can be lowered. Hypoglycin is more in unripe fruit than in ripe fruit. The toxicity of hypoglycin in ripe fruit decreases when it ripens, making it safe to eat.
Ackee is proposed as a possible agent responsible for prostate cancer in Jamaican males due to its high content of linoleic acid. But, studies show that oleic acid, which reduces the risk of prostate cancer, is predominantly present in ackee. The oleic acid content of ackee and avocado is nearly the same. The monounsaturated fatty acids (MUFA) in ackee, which are similar to that in avocado, can also offer protection against prostate cancer. There are no proven studies to associate the link between ackee and prostate cancer.
Ackee and lychee belong to the same family called Sapindaceae or the soapberry family. Both fruits are unsafe to be consumed when unripe and contain toxins. The longan fruit also belongs to this family. Lychee is a tropical fruit, and ackee is common in West Africa and is the national fruit of Jamaica. Ackee and lychee should be consumed when ripe, and ackee should be washed and cooked properly.
Source Article IclonSourcesSource Article Arrow
Dr. Sugreev Singh from iCliniq
Dr. Sugreev Singh

Internal Medicine

Consult this doctor

Rate this article

Tags:

food poisoning

Related topics

How to treat food poisoning-induced IBS?

Stomach Flu Versus Food Poisoning

Emergency Management of Food Poisoning

Can symptoms of food poisoning last for four months?

How can food poisoning be managed at home?

How To Avoid Food Poisoning and Diarrhea During A Holiday Trip?

Ask your health query to a doctor online

General Medicine

*guaranteed answer within 4 hours

Trustpilot

Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.