What is Ackee Fruit Toxicity?
If you eat the unripe Ackee fruit (Blighia sapida), you could get a health condition called “Jamaican vomiting sickness.” This condition can lead to intense vomiting, confusion, and low blood sugar. In severe instances, it can even cause seizures, abnormally low body temperature, a coma, or even death. Doctors mainly treat this sickness by giving patients fluids and a type of sugar called dextrose, typically through an IV.
What Causes Ackee Fruit Toxicity?
The ackee fruit is made up of three sections, each including a big black seed and a yellow part that can be eaten, known as the aril. In its initial stages, the aril of the fruit contains high levels of a harmful substance called hypoglycin. As the fruit matures, these toxin levels reduce to a point where eating the fruit is safe. The danger arises if you eat the fruit when it’s not yet ripe.
Being able to spot the difference between a ripe ackee fruit and an unripe one can help prevent health problems. You can tell if an ackee fruit is ripe by its yellow-red or red color, and it will also be wide open and show seeds quite clearly. On the other hand, an unripe fruit is green or yellow and won’t be open, making the seeds harder to see. Importantly, even if you cook an unripe fruit, it won’t eliminate the toxic threat. Furthermore, the seeds themselves are always toxic, and you should never eat them.
Risks of getting sick from eating ackee fruit include consuming an unripe fruit, buying fruit that’s been tampered with, or using water that was previously used to cook unripe ackee fruit.
Risk Factors and Frequency for Ackee Fruit Toxicity
The Blighia sapida tree, which originates from West Africa, was brought to Jamaica in 1778, where it became the national fruit and a significant part of the local diet. The frequency and impact of illnesses linked to this tree in Jamaica are not well-known and may be more significant than reported. The disease is most common during the Jamaican winter season when the fruit is not fully ripe. The Blighia sapida tree can also be found in southern Florida, various Caribbean countries, and Central America.
- The ackee fruit from this tree, when imported into the United States, is closely regulated by the Food and Drug Administration (FDA) to limit the presence of the dangerous toxin, hypoglycin A.
- There have been only a few reported cases of illness linked to this toxin in the United States.
- Children and malnourished individuals are most susceptible to the negative effects of this toxin.
Signs and Symptoms of Ackee Fruit Toxicity
Jamaican vomiting sickness is a potentially serious illness that can develop within six to 48 hours after someone eats an unripe Ackee fruit. Sometimes the symptoms can appear quicker in more severe cases. Once symptoms begin, they might ease for about 10 hours before they return. Although vomiting is a common symptom, its absence does not eliminate the possibility of having the sickness. Unlike other gastrointestinal illnesses, diarrhea is usually not present in this condition.
- Vomiting (though its absence doesn’t rule out the condition)
- No signs of diarrhea (helps distinguish from other illnesses)
- Seizures (indication of severe cases, found in 85% of fatal cases)
- Changes in mental state
- Tremors
- Abnormal skin sensations, such as tingling or numbness (paresthesias)
A detailed discussion about the patient’s recent meals can often help in identifying if they consumed any Ackee fruit – the cause of this sickness. The severity of the disease depends on how much of the unripe fruit the person ate. Most people recover within a week if they get timely medical attention.
Testing for Ackee Fruit Toxicity
If you are suspected to have Jamaican vomiting sickness, it’s important that you are taken to a hospital for examinations and closer observation. The doctors will insert an IV into you to give fluids and sugar, if necessary.
They will also run several tests including checking your blood sugar, salt levels in your blood, liver function, kidney function, lactate, ketones, and blood gases. If your symptoms are severe, the doctors will need frequent updates about the results of these tests, particularly your blood sugar and electrolyte levels.
One early sign of the disease can be seen on an ECG – a test that checks your heart’s activity. This can show if there are any unusual levels of electrolytes before lab results can.
There are also particular substances, hypoglycin, and its byproduct MCPA, that doctors can check for in your blood and pee. However, sometimes these substances might have already been flushed out of your system.
Further tests that aid in confirming the diagnosis are an increase in the concentrations of a substance called carnitine in your blood or urine, and another increase in the concentrations of a substance called dicarboxylic acid in your urine.
Treatment Options for Ackee Fruit Toxicity
Currently, there is no direct cure for the poisoning caused by hypoglycemia A. The main way to help patients is through supportive treatments. This includes close monitoring of the patient’s blood sugar levels and giving them dextrose, a type of sugar, to combat low blood sugar. If necessary, dextrose can be given continuously via an infusion to keep blood sugar levels stable.
Patients should also receive intravenous fluids to prevent dehydration, and antiemetic medicines to relieve symptoms of nausea and vomiting. Because vomiting and dehydration can lead to abnormal levels of electrolytes in the body, medical care should include restoring these to a healthy range.
Seizures can also occur in these cases and can be treated with a type of medication called benzodiazepines. However, it’s important to double-check that low blood sugar isn’t causing the seizures.
If there’s a risk of toxicity and the patient sought treatment within a few hours of consuming the toxic substance, stomach-cleaning procedures such as activated charcoal and gastric lavage, may be considered. While they might help, evidence regarding their consistent effectiveness in improving patient outcomes is rather limited. Using syrup of ipecac to induce vomit after toxic ingestion doesn’t have a role in these scenarios.
Certain supplements like riboflavin and glycine might be used in treatment as they’re believed to counteract the effects of hypoglycin A. Methylene blue is another option under consideration as a possible treatment for severe brain disease related to the poisoning. However, the true effectiveness of these supplements is still not entirely clear.
Experts in medical toxicology can provide valuable guidance in these cases. You can get in touch with them via the local Poison Control Center. Patients who continue to exhibit low blood sugar, seizures, metabolic acidosis (a high level of acid in the body), alteration in mental state, or poor circulation may need to be admitted to an intensive care unit.
In order to prevent future cases, education on the dangers of consuming unripe Ackee fruits, a primary cause of this type of poisoning, is crucial.
What else can Ackee Fruit Toxicity be?
Here are some other conditions with symptoms that may be mistaken for a stomach issue:
- Acute gastritis (sudden inflammation or swelling in the stomach lining)
- Acute poisoning (harmful effects from consuming or being exposed to dangerous substances)
- Aspirin poisoning (overdose or harmful effects from taking too much aspirin)
- Hypoglycemia (low blood sugar)
- Influenza (commonly known as flu)
- Intestinal obstruction (blockage preventing food or liquid from passing through the small or large intestine)
- Meningitis (infection causing inflammation of the membranes covering the brain and spinal cord)
- Sulfonylurea poisoning (overdose or harmful effects from a type of diabetes medication)
These conditions can often be confused with each other due to their similar symptoms. It’s important for doctors to run appropriate tests to pinpoint the exact cause of the symptoms.
