Laboratory Studies
Laboratory studies include:
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Fingerstick glucose/rapid glucose determination to evaluate for hypoglycemia (Glucose levels as low as 3 mg/dL have been reported.) [10]
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Chemistry panel (sodium, potassium, chloride, carbon dioxide, blood urea nitrogen, and creatinine levels) to evaluate for acidosis, hypokalemia, and electrolyte disturbance as a cause for vomiting
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Serum ketone levels (if present, suggest other cause of hypoglycemia)
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Urinalysis in ackee poisoning shows acidosis and no ketosis.
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Serum ammonia level (Hyperammonemia is characteristic.)
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Liver transaminase level and prothrombin time (PT)/activated partial thromboplastin time (aPTT) to assess extent of liver toxicity
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Arterial pH to evaluate acid/base status
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Serum lactate levels (may be elevated)
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Cerebrospinal fluid (generally reveals low glucose level)
Imaging Studies
Nonenhanced head CT may be performed to exclude intracranial pathology as a cause for altered mental status, seizures, or focal neurologic deficits.
Other Tests
Gas chromatography of urine: Excess excretion of medium-chain dicarboxylic acids, such as 2-ethylmalonic, 2-methylsuccinic, and glutaric acid, is a distinctive finding in this illness.
Presence of positive serum or urine level of hypoglycin A or its metabolite methylenecyclopropyl acetic acid (MCPA) indicates exposure to ackee fruit.
Autopsy findings include massive steatosis of the liver (comparable with Reye syndrome).
Procedures
Endotracheal intubation: A secure airway may be necessary for patients presenting with seizures or coma.
Intravenous access: Intravenous access may be needed to administer glucose-containing solutions, intravenous antiemetics and anticonvulsants, and volume resuscitation.
