title: Severe encephalopathy after ingestion of star fruit juice in a patient with chronic renal failure admitted to the intensive care unit.
abstract: Star fruit (Averrhoa carambola) is a popular tropical fruit that is usually consumed as fresh fruit or fruit juice. Consumption of star fruit by patients with chronic renal failure can lead to neurologic symptoms. The present report describes the clinical course, management, and outcome of a patient with chronic renal failure admitted to an intensive care unit after ingestion of star fruit juice 2 days before hospital admission. A case of nausea, vomiting, intractable hiccups, and severe encephalopathy along with mental confusion, disorientation, agitation, and seizures in a 53-year-old woman is presented. The patient's ventilatory pattern worsened, with development of dyspnea and tachypnea, which resulted in her transfer to an intensive care unit. Although hemodialysis was performed and the septic shock was adequately treated, the patient died on the fifth day after hospital admission. The susceptibility of patients with chronic renal failure to star fruit and the severity of intoxication are poorly known by intensivists. This case demonstrates that star fruit consumption should be considered as a cause of rapid deterioration in the renal function of patients with underlying chronic renal failure, potentially resulting in a fatal outcome.
authors.affiliation: Centro de Terapia Intensiva (Campus), Departamento de Cirurgia e Anatomia, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo-HCFMRP-USP, Bairro Monte Alegre, Ribeirão Preto, SP, Brasil.
authors.forename: Maria
authors.initials: M
authors.lastname: Auxiliadora-Martins
authors.forename: Gil Cezar
authors.initials: GC
authors.lastname: Alkmin Teixeira
authors.forename: Graciana Soares
authors.initials: GS
authors.lastname: da Silva
authors.forename: Jaciara Machado
authors.initials: JM
authors.lastname: Viana
authors.forename: Edson Antônio
authors.initials: EA
authors.lastname: Nicolini
authors.forename: Olindo Assis
authors.initials: OA
authors.lastname: Martins-Filho
authors.forename: Anibal
authors.initials: A
authors.lastname: Basile-Filho
mesh_terms: D001928:Brain Diseases, Metabolic / Q000139:chemically induced*; D003221:Confusion; D017809:Fatal Outcome; D005260:Female; D005638:Fruit / Q000009:adverse effects*; D006801:Humans; D007362:Intensive Care Units; D007676:Kidney Failure, Chronic / Q000503:physiopathology*; D008875:Middle Aged; D020258:Neurotoxicity Syndromes; D011595:Psychomotor Agitation; D012640:Seizures; D012720:Severity of Illness Index; D012772:Shock, Septic