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Hypoglycemic Plant Poisoning

Practice Essentials

More than 270 plant species have been identified as having hypoglycemic potential. Many of these plants are used in developing countries in the treatment of diabetes. The most well known of these plants are listed below:

Herb fenugreek (
Trigonella foenum-graecum)

Bitter melon gourd (
Momordica charantia)

Climbing ivy gourd (
Coccinia indica)

Mamijava (
Enicostemma littorale)

Asian ginseng (
Panax ginseng)

American ginseng (
Panax quinquefolius)

Siberian ginseng (
Eleutherococcus senticosus)

Ackee tree (
Blighia sapida)

Prickly pear (
Opuntia robusta)

Yellow bells (
Tecoma stans [family Bignoniaceae])

Most of the plants studied have shown minimal-to-moderate effects on glucose regulation, with the exception of ackee fruit and bitter melon. Bitter melon produces hypoglycemia via steroidal saponins (charantin, insulinlike peptides, and alkaloids), but it has never been reported to result in fatality. Methylenecyclopropylglycine (MCPG) and hypoglycin A (HGA) are naturally-occurring amino acids found in some soapberry fruits. Fatalities have been reported worldwide as a result of HGA ingestion, and exposure to MCPG has been implicated recently in the Asian outbreaks of hypoglycemic encephalopathy.

This article focuses on the potentially fatal effects produced by ackee fruit ingestions due to HGA contained in the fruit.
 In addition, several references regarding other plants with hypoglycemic effects have been included.

Ackee fruit is produced biannually by the tropical evergreen tree, Blighia sapida. Although indigenous to West Africa, it is commonly found in the Caribbean islands, Central America, South America, and southern Florida. In South America, the fruit has been used to treat colds, fever, and diseases as varied as edema and epilepsy, though no clinical trials support these uses. In Jamaica, ackee fruit is a food staple, commonly prepared like scrambled eggs or boiled with fish. The fruit itself is 10 cm wide and weighs 100 g. It houses 3 glossy, black seeds contained within a straw- to red-colored husk and covered by a thick, oily appearing yellow aril. The outer aril is closed in unripe ackee fruit. Upon ripening, the aril spontaneously opens.

Unripe fruit and the water used to cook it are toxic and cause Jamaican vomiting sickness when ingested (see Ackee Fruit Toxicity).
 Fatal epidemics of this illness have been well studied in Haiti, West Africa, and Jamaica. These epidemics tend to coincide with food shortages. The disease is characterized by profound hypoglycemia and intractable vomiting. Before widespread recognition of the hypoglycemia produced by this illness, the mortality rate approached 80%.

For patient education resources, see the First Aid and Injuries Center, as well as Food PoisoningPoisons, and Activated Charcoal.

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