Akmal, the only wicket-keeper in the squad, appeared to injure his left index finger after taking a ball from Mohammad Asif in the fifth over on Thursday.
And just before lunch on the first day of this four-day match, Pakistan's last first-class fixture before they meet England in the first of a four-Test serie at Lord's, the normally reliable Akmal dropped a straightforward catch to give England A skipper Robert Key a reprieve on 30 off Mohammad Asif.
At lunch Key was 30 not out and current Test batsman Ian Bell 36 not out, the duo putting on fifty in 95 balls.
Pakistan did not have long to wait for a breakthrough with Alastair Cook, set to be one of their Lord's opponents a week on Thursday, being well caught by a diving Akmal for three after pushing forward defensively at Mohammad Sami to leave England A four for one in the fourth over.
But Akmal, after a few minutes of on-field treatment, continued although he looked uncomfortable.
Meanwhile former England batsman Key, captaining the side on his Kent home ground, got off the mark with a cover-driven four off Asif and later pulled the paceman for six behind square leg.
Key, 27, who had shoulder surgery during the off-season and has not played for the England Test side since appearing against South Africa at Centurion last year, and Bell, driving elegantly, then consolidated.
Pakistan made four changes to the side that beat Leicestershire by eight wickets in a three-day game at Grace Road concluded Monday.
Captain Inzamam-ul-Haq returned in place of vice-captain Younis Khan, Mohammad Yousuf took the place of fellow batsman Shahid Afridi, Abdul Razzaq came in for all-rounder Shoaib Malik and Asif was given a pace spot ahead of seamer Shahid Nazir.