New Development of Hypoglycemia in a Previously Poorly-Controlled Type 2 Diabetic: Ackee Fruit-Induced Hypoglycemia

Abstract

Objective: To report a case of hypoglycemia due to Ackee fruit consumption.Methods: This is a case report and brief review of literature. Results:We report a patient with new onset hypoglycemia due to the consumption of the Ackee fruit. Patient is a 95-year-old Jamaican male with history of uncontrolled, insulin requiring Type 2 diabetes mellitus. He presented with new onset of hypoglycemia and improvement in hemoglobin A1C without any changes in diabetes regimen, other medications or co-morbidities. On investigative questioning, he reported that he had recently received a jar of preserved Ackee fruit, and was consuming small portions of it daily. This coincided with the development of hypoglycemia. Conclusion:Despite being uncommonly used in the United States, Ackee fruit consumption is a known cause of hypoglycemia. Ackee fruit contains two toxins, hypoglycin A and hypoglycin B that work through the same mechanism to deplete hepatic glycogen stores and cause refractory hypoglycemia. The most severe form of Ackee-fruit toxicity is known as "Jamaican Vomiting Sickness". The disorder is characterized by symptoms of severe hypoglycemia and seizures, ultimately leading to coma and death. Although rare in the United States, it is important to understand and recognize the symptoms of Ackee fruit induced toxicity to avoid late detection and severe complications.

Evaluation of neurotoxicity and hepatotoxicity effects of acute and sub-acute oral administration of unripe ackee (Blighia sapida) fruit extract

“…The edible arils are rich source of protein, fat and vitamins A, B1, B2 and C [1]. The matured fruit is considered a staple food prepared by cooking or roasting among the poor population in West Africa or canned food in Jamaica [5,6].…”

“…Hypoglycin B being found mainly in the seed is known to possess less potent hypoglycaemic activity as compared to hypoglycin A [10]. The mechanism of ackee poisoning has been closely associated with hypoglycaemia [5]. This toxic component in the immature fruit is shown to exhibit toxic mechanism by inhibition of the enzyme in fatty acid β-oxidation, flavoprotein acyl-CoA dehydrogenase as well as other acyl-CoA dehydrogenases (the short-chain acyl-CoA dehydrogenase, medium-chain acyl-CoA dehydrogenase and isovaleryl-CoA dehydrogenase [11].…”