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Chu YC, Ho MP. Star fruit intoxication with impaired renal function. Am J Emerg Med 2024; 76:236. [PMID: 37741784 DOI: 10.1016/j.ajem.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 09/25/2023] Open
Affiliation(s)
- Yu-Chuang Chu
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Min-Po Ho
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
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Raciti C, Blanzaco M, Bernstein J. Death associated with ingestion of starfruit (Averrhoa carambola) in a patient with chronic kidney disease. Am J Emerg Med 2023:S0735-6757(23)00336-4. [PMID: 37394384 DOI: 10.1016/j.ajem.2023.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/28/2023] [Accepted: 06/22/2023] [Indexed: 07/04/2023] Open
Abstract
We detail a case of a 74-year-old female with a history of chronic kidney disease (CKD) and diabetes mellitus (DM) who initially presented to the Emergency Department (ED) with intractable hiccups after ingesting two whole starfruit (SF) and quickly became critically ill while in the ED. Our patient was admitted and received several rounds of hemodialysis, but efforts proved futile, as the patient expired during her hospital course. To the best of our knowledge, this is the first fatality reported due to SF ingestion in the U.S, and highlights the need for both a better understanding of SF intoxication and clearer guidelines and timing for treatment. Due to the increased mortality of patients who consume SF with a medical history of CKD or DM, it is prudent that Emergency Physicians are familiar with the clinical presentation and management options for SF toxicity.
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Affiliation(s)
- Christopher Raciti
- Department of Emergency Medicine, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL 33140, USA.
| | - Melba Blanzaco
- Florida Poison Information Center, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Highland Professional Building, 1(st) Floor, 1801 NW 9(th) Avenue, 1(st) Floor, Miami, FL 33136, USA
| | - Jeffrey Bernstein
- Florida Poison Information Center, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Highland Professional Building, 1(st) Floor, 1801 NW 9(th) Avenue, 1(st) Floor, Miami, FL 33136, USA; Department of Emergency Medicine, Jackson Memorial Hospital, 1611 N.W. 12th Avenue, Miami, FL 33136, USA
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Li A, Chen B, Jin X, Bai Y, Zhang J, Zhang C, Cheng M, Guo C, Zhang Y, Zhou J. Antiepileptic therapy in a patient with star fruit intoxication: A case report. Medicine (Baltimore) 2023; 102:e32969. [PMID: 36862861 PMCID: PMC9981371 DOI: 10.1097/md.0000000000032969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
RATIONALE It is rare for uremia patients to have epileptic seizures after eating star fruit, only a dozen cases are reported worldwide. Such patients usually have poor prognoses. Few patients had good prognoses, all of them were treated with expensive renal replacement therapy. At present, there is no report on the addition of drug therapy to these patients based on the initial renal replacement therapy. PATIENT CONCERNS A 67-year-old male patient with star fruit intoxication who had a history of diabetic nephropathy, hypertension, polycystic kidney, and chronic kidney disease in the uremic phase, and regular hemodialysis 3 times a week for 2 years. Initial clinical manifestations include hiccups, vomiting, speech disturbances, delayed reactions, and dizziness, which gradually progress to hearing and visual impairment, seizures, confusion, and coma. DIAGNOSES This patient was diagnosed with seizures caused by star fruit intoxication. The experience of eating star fruit and the electroencephalograms can prove our diagnosis. INTERVENTIONS We performed intensive renal replacement therapy according to the recommendations in the literature. However, his symptoms did not improve significantly until he received an extra dose of levetiracetam and resumed his previous dialysis schedule. OUTCOMES The patient was discharged after 21 days without neurologic sequelae. Five months after discharge, he was readmitted due to poor seizure control. LESSONS To improve the prognosis of these patients and to reduce their financial burden, the use of antiepileptic drugs should be emphasized.
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Affiliation(s)
- Aixun Li
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Baoxin Chen
- Department of Neurology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xianglan Jin
- Department of Neurology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yu Bai
- Department of Nephrology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jingfeng Zhang
- Department of Nephrology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chengcheng Zhang
- Department of Nephrology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Miaomiao Cheng
- Department of Neurology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chunyan Guo
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yu Zhang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Jing Zhou
- Department of Neurology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing, China
- * Correspondence: Jing Zhou, Staff Physician, Department of Neurology, Dong Fang Hospital, Beijing University of Chinese Medicine, No. 6, Zone 1, Fangxingyuan, Fengtai District, Beijing 100078, China (e-mail: )
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Luan F, Peng L, Lei Z, Jia X, Zou J, Yang Y, He X, Zeng N. Traditional Uses, Phytochemical Constituents and Pharmacological Properties of Averrhoa carambola L.: A Review. Front Pharmacol 2021; 12:699899. [PMID: 34475822 PMCID: PMC8407000 DOI: 10.3389/fphar.2021.699899] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/02/2021] [Indexed: 11/25/2022] Open
Abstract
Averrhoa carambola L. (star fruit) is an edible fruit that is extensively cultivated in southern China, Southeast Asia, India, and northern South America. It has a sweet and juicy taste and is frequently used in fruit salads and fruit platters, as a garnish in cocktail drinks and beverages, or squeezed into juice and served as a beverage. Traditionally, it has been used for treating diabetes and diabetic nephropathy, arthralgia, vomiting, lithangiuria, coughing, hangovers, and chronic paroxysmal headache for thousands of years. Currently, approximately 132 compounds have been isolated from A. carambola. Among them, flavonoids, benzoquinone, and their glycosides have been considered as biologically active substances, which are responsible for various biological activities. Pharmacological studies have revealed that crude extracts or monomeric compounds from A. carambola exhibit multiple bioactivities, such as anti-oxidant, anti-hyperglycemic, anti-obesity, anti-hyperlipidemic, anti-tumor, anti-inflammatory, hepatoprotective, cardioprotective, anti-hypertensive, neuroprotective, and others. Thus, A. carambola is a valuable treatment in Chinese medicine with therapeutic potential for multiple diseases, especially diabetes and diabetes-related diseases. Even though it is a very promising candidate in the development of functional food and the pharmaceutical industry, reports on its bioactivities have only been conducted in vivo and in vitro and there is a gap in research regarding clinical settings and safety. This review therefore provides a comprehensive and systematic overview of current progress on botany, ethnopharmacology, phytochemistry, pharmacology, and toxicity of A. carambola, providing a valuable reference for further developments and applications of A. carambola in the pharmaceutical industry and functional food.
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Affiliation(s)
- Fei Luan
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lixia Peng
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ziqin Lei
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiyu Jia
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Junbo Zou
- Department of Pharmacology, College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Yan Yang
- Department of Bioengineering, Zhuhai Campus of Zunyi Medical University, Zhuhai, China
| | - Xirui He
- Department of Bioengineering, Zhuhai Campus of Zunyi Medical University, Zhuhai, China
| | - Nan Zeng
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Cornara L, Xiao J, Smeriglio A, Trombetta D, Burlando B. Emerging Exotic Fruits: New Functional Foods in the European Market. EFOOD 2020. [DOI: 10.2991/efood.k.200406.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Stumpf MAM, Schuinski AFM, Baroni G, Ramthun M. Acute Kidney Injury with Neurological Features: Beware of the Star Fruit and its Caramboxin. Indian J Nephrol 2019; 30:42-46. [PMID: 32015601 PMCID: PMC6977387 DOI: 10.4103/ijn.ijn_53_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/29/2019] [Accepted: 06/11/2019] [Indexed: 11/17/2022] Open
Abstract
Star fruit (Averrhoa carambola) is a well-known product in tropical countries. There are few reports published in literature with acute kidney injury due to oxalate induced nephropathy. However, none of them have an important neurological feature. We present a case of a 51-year-old male with paresis and altered mental status. Screening for neurological diseases such as stroke, Guillain-Barre, meningitis and encephalitis were negative. In the evolution, he developed acute kidney failure and was submitted to 4 dialysis sessions. After talking to the family, we discovered he had ingested over 50 star fruits prior to the acute neurologic deficits. He recovered renal function so a renal biopsy was not required. Physicians should actively look for star fruit ingestion history in patients presenting with unexplained acute kidney injury with or without neurological features. Besides, taking star fruit in a large amount, accompanied by an empty stomach and dehydrated state, is a risk factor for neurotoxicity.
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Affiliation(s)
- Matheo A M Stumpf
- Department of Medicine, Ponta Grossa State University, Ponta Grossa, Brazil
| | | | - Gilberto Baroni
- Department of Medicine, Ponta Grossa State University, Ponta Grossa, Brazil
| | - Maikel Ramthun
- Department of Medicine, Ponta Grossa State University, Ponta Grossa, Brazil
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