title: Star fruit intoxication in uraemic patients: case series and review of the literature.
abstract: Star fruit, belonging to the Oxalidaceae family, species Averrhoa carambola, is a popular fruit among Orientals. There have been reports of hiccup, confusion, and occasional fatal outcomes in uraemic patients after ingestion of star fruit. An excitatory neurotoxin from star fruit has been implicated although the exact nature of this toxic substance has not been identified. A group of seven patients is described from the dialysis centres at Queen Mary and Tung Wah Hospitals who developed symptoms including hiccup, confusion, vomiting, impaired consciousness, muscle twitching and hyperkalaemia shortly after ingestion of star fruit. Symptoms of most patients resolved after intensified dialysis or spontaneously, and no mortality was observed. The close temporal relationship of ingestion of star fruit and onset of symptoms strongly suggests the existence of a causal relationship between the two. It is recommended that uraemic patients should totally abstain from star fruit due to these rare but potentially fatal complications. The clinical manifestations of other reported series and current evidence for the possible candidate(s) of the neurotoxin are discussed.
authors.affiliation: Division of Nephrology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors.forename: K-C
authors.initials: KC
authors.lastname: Tse
authors.forename: P-S
authors.initials: PS
authors.lastname: Yip
authors.forename: M-F
authors.initials: MF
authors.lastname: Lam
authors.forename: B-Y
authors.initials: BY
authors.lastname: Choy
authors.forename: F-K
authors.initials: FK
authors.lastname: Li
authors.forename: S-L
authors.initials: SL
authors.lastname: Lui
authors.forename: W-K
authors.initials: WK
authors.lastname: Lo
authors.forename: T-M
authors.initials: TM
authors.lastname: Chan
authors.forename: K-N
authors.initials: KN
authors.lastname: Lai
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005638:Fruit / Q000506:poisoning*; D006723:Hong Kong; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D020258:Neurotoxicity Syndromes / Q000209:etiology*; D009498:Neurotoxins / Q000009:adverse effects; D010939:Plant Poisoning / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality; D006435:Renal Dialysis; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D014511:Uremia / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy
chemical_list: D009498:Neurotoxins