Outbreaks of this illness reach epidemic proportions when food is scarce and unripe ackee fruits are available. Profound hypoglycemia is the disease's hallmark. Beta-oxidation of fatty acids normally requires fatty acid transport into mitochondria via a carnitine transporter. Incidence in Jamaica has been estimated to be 1 case per 100,000 persons per year. Morbidity and mortality are highest in poor and malnourished patients.
Children are more likely than adults to experience fatal complications of ackee fruit ingestion.
The patient or the patient's family may provide a history of ingesting unripe ackee fruit or water in which unripe ackee had been cooked. More than one family member may be ill. Some individuals may be reluctant to give a history of ackee fruit ingestion because of perceived legal repercussions. Patients may present with complaints of vomiting, intense thirst, altered mental status, hypotonia, or seizures. Death may occur within 12 hours in severe cases.