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10-13-2021 | Hypoglycemia | View from the clinic | Article

Endemic hypoglycemia

Author:
Sanjay Kalra

The clinical challenge

While hypoglycemia is ubiquitous in the diabetes care world, there are some causes of hypoglycemia which are endemic to specific areas. Examples include Jamaican vomiting sickness and litchi-included encephalopathy in India. These have a unique pathogenesis, which calls for specific clinical and public health interventions. Awareness about such conditions, and their screening and treatment, is necessary to ensure proper management and optimal resolution.

Children who develop hypoglycemia due to ackee or litchi fruit must be treated with intravenous dextrose, and built up with a balanced diet.


Image: Ackee fruit; credit: princekojo/Pixabay

A pragmatic solution

Jamaican vomiting sickness is caused by intake of the unripe ackee fruit, while litchi-included encephalopathy is due to excessive intake of the litchi fruit. Hypoglycemia occurs due to release of toxins which impair hepatic gluconeogenesis. Ackee fruit toxicity is associated with gastrointestinal symptoms, and litchi poisoning leads to hypoglycemia encephalopathy. A pragmatic approach to management should include both clinical and public health interventions.

Prevention of malnutrition is the most important preventive strategy, as these illnesses are found in malnourished children. Public awareness about the side effects of eating unripe fruit must be spread. Children who develop hypoglycemia due to ackee or litchi fruit must be treated with intravenous dextrose, and built up with a balanced diet. It may be necessary to continue monitoring after clinical recovery. Co-existent infection, such as acute gastroenteritis and meningitis, and comorbidity, like dyselectrolytemia, must be ruled out or treated.

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About the author

Sanjay Kalra

Sanjay Kalra, MBBS MD DM (AIIMS New Delhi), is an endocrinologist based at Bharti Hospital, Karnal, India.


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