This chapter focuses on ingestions of ackee fruit, which produce hypoglycemia due to a chemical constituent of the fruit, hypoglycin A. Ackee fruit comes from the tree Blighia sapida , which is indigenous to West Africa but prevalent in the West Indies, including Cuba, Jamaica, and the Bahamas, as well as Central America and southern Florida. The aril is closed in unripe ackee fruit. With ripening, the aril spontaneously opens. Unripe fruit arils are toxic and when consumed produce an illness termed Jamaican vomiting sickness . 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.