Nephrol Dial Transplant (2003) 18: 120-125
© 2003 European Renal Association-European Dialysis and Transplant Association
Intoxication by star fruit (Averrhoa carambola) in 32 uraemic patients: treatment and outcome
1 Nephrology Division of Department of Internal Medicine, 2 Department of Physiology and 3 Department of Biochemistry, School of Medicine of Ribeirao Preto, University of Sao Paulo and 4 Serviço de Nefrologia de Ribeirao Preto, Ribeirao Preto, Sao Paulo, Brazil
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.
Keywords: Averrhoa carambola; hiccups; neurotoxicity; star fruit intoxication; treatment; uraemia
Correspondence and offprint requests to: Miguel Moyses Neto, Department of Internal Medicine, School of Medicine of Ribeirao Preto, University of Sao Paulo, Campus Monte Alegre 14048-900, Ribeirao Preto, Sao Paulo, Brazil. Email: mmoyses{at}convex.com.br
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  M. Hidaka, K.-i. Fujita, T. Ogikubo, K. Yamasaki, T. Iwakiri, M. Okumura, H. Kodama, and K. Arimori POTENT INHIBITION BY STAR FRUIT OF HUMAN CYTOCHROME P450 3A (CYP3A) ACTIVITY Drug Metab. Dispos., June 1, 2004; 32(6): 581 - 583. [Abstract] [Full Text] [PDF]
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