Toxin mediated encephalopathy has emerged as a major cause affecting children in recent years. Encephalopathy linked to litchis has been reported in epidemic forms in Muzaffarpur, Bihar, and Malda, Bengal. Every year, during the harvest period in the months of April-June, surge in deaths due to AES, predominantly in children has been observed. The victims are usually malnourished children of lower socio-economic strata. The toxins present in the fruit—hypoglycin-A and methylene cyclopropyl glycine (MCPG)—result in severe fatty acid oxidation inhibition and hypoglycaemia. They impair the energy producing mechanisms in the body, leading to reduced blood sugar. This in turn leads to reduced energy supply to the brain and impaired brain functions, resulting in encephalopathy. Malnourished children are highly vulnerable due to a reduced store of energy. Two studies, so far, have found an association with litchi consumption, prolonged fasting and malnutrition.