Introduction:
Several plant species may produce some toxic substances as a part of the plant's defense mechanism against predators. People consume ackee for various conditions, but there is no proper scientific evidence for the usage of these products. Therefore, these products have been banned in the United States for the past 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 the 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 any potential side effects. Ripe ackee fruit is yellow-red to red in color 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:
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Eating an unripe ackee.
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Purchasing tampered ackee.
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Consuming the water used to cook unripe ackee.
What Is Ackee Poisoning?
Hypoglycin A is the toxin found in the ackee fruit that can cause acute toxicity. It is also called Jamaican vomiting sickness or toxic hypoglycemic syndrome. This fruit grows in the ackee plant, 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 taken as food and is considered a dietary staple (like cereal grains and tuber) in Jamaica. Toxicity occurs only with the ingestion of the 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 to consume due to hypoglycin A and B. The unripe fruit can cause severe hypoglycemia, often accompanied by convulsions and death.
What Are the Symptoms of Ackee Poisoning?
The symptoms of poisoning from consumption of unripe ackee and the 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:
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Cholestatic jaundice.
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Vomiting.
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Hypoglycemia.
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Potentially death.
It may take about six to 48 hours for the onset of symptoms after the ingestion of 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 time of 12.5 hours.
The other symptoms in a few cases 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, pregnant and breastfeeding women as the unripe ackee fruit contains hypoglycin A at higher concentrations than ripe ackee fruit.
What Is the Differential Diagnosis of Ackee Poisoning?
The differential diagnosis of ackee poisoning may include:
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Acute gastritis.
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Influenza.
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Hypoglycemia
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Acute poisoning in general.
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Aspirin poisoning.
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Intestinal obstruction.
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Sulfonylurea poisoning.
How to Treat Ackee Poisoning?
Currently, 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 to relieve symptoms like vomiting. Vomiting and dehydration can lead to electrolyte imbalance which should be replaced.
Medications:
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Benzodiazepines may be used to treat seizures.
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GI (gastrointestinal) decontamination is done with activated charcoal and gastric lavage when there is potential toxicity and also if the patient is rushed to the hospital within a few hours of ingestion. But there is no evidence that GI decontamination can improve patient outcomes. Riboflavin and glycine are included in the treatment to antagonize hypoglycin A.
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Methylene blue is used for potentially fatal encephalopathy.
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Patients with symptoms like seizures, hypoglycemia, metabolic acidosis, poor perfusion, or altered mental status will require admission to an intensive care unit (ICU).
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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 team of 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.
How to Prevent Ackee Poisoning?
The best way to prevent ackee poisoning is by avoiding the consumption of unripe ackee fruit and water in which the ackee fruit has been boiled.
Conclusion:
The 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 prevent morbidity and mortality.