Lychee Hypoglycemia and Lychee encephalopathy

Dr K K Aggarwal

1. Lychee fruit consumption followed by fasting
2. Lychee fruit consumption after overnight fasting in the morning
3. Doing only Lychee fast

Are been associated with outbreaks of hypoglycemia and encephalopathy with high mortality.

Metabolites of hypoglycin A and methylene-cyclo-propyl-glycine MCPG were found in two-thirds of urine specimens from the victims.

Ackee fruit (Blighia sapida) is a common food source in West Africa and the

Caribbean, especially among impoverished and malnourished children.

Edible when ripe and properly prepared, the unripe fruit contains high concentration of the toxin, hypoglycin A, which, when metabolized, inhibits long chain fatty acid breakdown and transport into the mitochondria.

Toxicity manifests as a Reye-like syndrome with vomiting, hypoglycemia, seizures, and coma occurring between 2 and 48 hours after ingestion of unripe ackee fruit. Without rapid correction of hypoglycemia, the death rate approaches 100 percent.
Pathologic findings on liver biopsy include cholestasis and centrilobular necrosis.

Symptoms of hypoglycemia include neurogenic (autonomic) symptoms and neuroglycopenic symptoms.

The severity of symptoms may or may not predict the severity of the hypoglycemia.

Neuroglycopenic symptoms typically occur at lower plasma glucose levels than autonomic symptoms.

However, with repeated episodes of hypoglycemia, the threshold glucose concentration for adrenergic symptoms decreases, such that they may not appear before the onset of neuroglycopenic symptoms

Autonomic symptoms of hypoglycemia in children and adults are due to increased adrenergic activity, and include sweating, weakness, tachycardia, tremor, and feelings of nervousness, and/or hunger.

Neuroglycopenic symptoms include lethargy, irritability, confusion, behavior that is out of character, and hypothermia. In extreme hypoglycemia, seizure and coma may occur.

In infants, symptoms of hypoglycemia are nonspecific and include jitteriness, irritability, feeding problems, lethargy, cyanosis, and tachypnea.
When hypoglycemia is suspected, a rapid (bedside) plasma glucose determination should be performed.

If it is low (≤50 mg/dL for this initial bedside measurement), critical samples should be obtained before treatment, if this can be done without delaying treatment. Obtaining critical samples before the initiation of therapy, and collecting the first voided urine sample, can dramatically improve the ability to diagnose the etiology of the hypoglycemia and simplify the subsequent diagnostic evaluation.

These symptoms and signs occur at plasma glucose concentrations between 10 and 50 mg/dL. Severe and repeated episodes of hypoglycemia can result in permanent central nervous system damage, and occasionally in death.

Treatment
IV dextrose
Till it  is given give one TSF sugar with one drop of water sublingual every twenty minutes