title: Intoxication by star fruit (Averrhoa carambola) in 32 uraemic patients: treatment and outcome.
abstract: BACKGROUND
  Clinical symptoms and outcomes of uraemic patients ingesting star fruit are quite variable and may progress to death. The purpose of the present report was to discuss the neurotoxic effects of star fruit intoxication in uraemic patients and to present the efficacy of different therapeutic approaches.
  
  
  METHODS
  We studied a total of 32 uraemic patients who had ingested star fruit. Before the intoxication episodes, 20 patients were on regular haemodialysis, eight were on peritoneal dialysis and four were not yet undergoing dialysis. Two patients were analysed retrospectively from their charts, 17 were directly monitored by our clinic and 13 were referred by physicians from many areas throughout the country, allowing us to follow their outcome from a distance. Intoxicated patients were given different therapeutic approaches (haemodialysis, peritoneal dialysis and supportive treatment), and their outcomes were analysed.
  
  
  RESULTS
  The most common symptoms were persistent and intractable hiccups in 30 patients (93.75%), vomiting in 22 (68.7%), variable degrees of disturbed consciousness (mental confusion, psychomotor agitation) in 21 (65.6%), decreased muscle power, limb numbness, paresis, insomnia and paresthesias in 13 (40.6%) and seizures in seven (21.8%). Patients who were promptly treated with haemodialysis, including those with severe intoxication, recovered without sequelae. Patients with severe intoxication who were not treated or treated with peritoneal dialysis did not survive.
  
  
  CONCLUSIONS
  Haemodialysis, especially on a daily basis, is the ideal treatment for star fruit intoxication. In severe cases, continuous methods of replacement therapy may provide a superior initial procedure, since rebound effects are a common event. Peritoneal dialysis is of no use as a treatment, especially when consciousness disorders ensue.
authors.affiliation: Nephrology Division of Department of Internal Medicine, School of Medicine of Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil. mmoyses@convex.com.br
authors.forename: Miguel Moyses
authors.initials: MM
authors.lastname: Neto
authors.forename: José Abrão Cardeal
authors.initials: JA
authors.lastname: da Costa
authors.forename: Norberto
authors.initials: N
authors.lastname: Garcia-Cairasco
authors.forename: Joaquim Coutinho
authors.initials: JC
authors.lastname: Netto
authors.forename: Beatriz
authors.initials: B
authors.lastname: Nakagawa
authors.forename: Marcio
authors.initials: M
authors.lastname: Dantas
mesh_terms: D000328:Adult; D005260:Female; D005517:Foodborne Diseases / Q000150:complications* / Q000401:mortality; D005638:Fruit / Q000506:poisoning*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D008875:Middle Aged; D010530:Peritoneal Dialysis; D010531:Peritoneal Dialysis, Continuous Ambulatory; D006435:Renal Dialysis; D012189:Retrospective Studies; D027824:Rosaceae / Q000506:poisoning*; D016896:Treatment Outcome; D014511:Uremia / Q000150:complications*