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Association of renal function and symptoms with mortality in star fruit (Averrhoa carambola) intoxication.
Clin Toxicol (Phila). 2017 Aug; 55(7):624-628.CT

Abstract

BACKGROUND

Star fruit (SF) is a commonly available fruit produced and eaten in tropical and subtropical countries. Since 1993, various reports have described neurotoxicity after eating SF, but this clinical condition remains unfamiliar. We aimed to describe this clinical entity, the role of renal dysfunction in this disorder, treatment strategies, and prognosis of patients with SF intoxication.

METHODS

We conducted a search of PubMed and Google Scholar databases from 1993 to 2016. We included reports describing patients with a clear history of SF ingestion with acute symptoms. We described the demographic characteristics, reported SF intake, treatments used, and outcomes.

RESULTS

We reviewed totally 126 patients (male:female = 1.5:1) from 33 articles with mean age 54.4 ± 11 (range: 30-84). The most common symptom was hiccups (65%), whereas confusion and seizure were the most common symptoms associated with mortality (42% and 61%, respectively). Pre-intoxication renal function also affected mortality. While there was no mortality in patients with normal renal function (NRF), the mortality of patients among reported cases with chronic renal insufficiency and end-stage renal disease undergoing dialysis were 36% and 27%, respectively. With the inclusion of patients reported to have NRF, the overall mortality was 24%. Consistently, the number of SF consumed was substantially higher in the patients with NRF than those with renal functional impairment. The most common treatment strategy was hemodialysis (59%).

CONCLUSIONS

Patients with impaired renal function were at higher risks of SF intoxication. Severe neurologic symptoms mandate immediate medical intervention because of the association between their occurrence and high mortalities. Toxin removal through dialysis, rather than symptomatic relief, seems to be beneficial to patient survival. Early and continuous dialysis appears to alleviate severe symptoms and prevent symptom rebounds.

Authors+Show Affiliations

a Department of Emergency Medicine , E-Da Hospital, I-Shou University , Kaohsiung City , Taiwan.a Department of Emergency Medicine , E-Da Hospital, I-Shou University , Kaohsiung City , Taiwan.b Department of Neurology , E-Da Hospital, I-Shou University , Kaohsiung City , Taiwan.a Department of Emergency Medicine , E-Da Hospital, I-Shou University , Kaohsiung City , Taiwan.a Department of Emergency Medicine , E-Da Hospital, I-Shou University , Kaohsiung City , Taiwan.a Department of Emergency Medicine , E-Da Hospital, I-Shou University , Kaohsiung City , Taiwan.a Department of Emergency Medicine , E-Da Hospital, I-Shou University , Kaohsiung City , Taiwan.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

28443386

Citation

Chua, Choon-Bing, et al. "Association of Renal Function and Symptoms With Mortality in Star Fruit (Averrhoa Carambola) Intoxication." Clinical Toxicology (Philadelphia, Pa.), vol. 55, no. 7, 2017, pp. 624-628.
Chua CB, Sun CK, Tsui HW, et al. Association of renal function and symptoms with mortality in star fruit (Averrhoa carambola) intoxication. Clin Toxicol (Phila). 2017;55(7):624-628.
Chua, C. B., Sun, C. K., Tsui, H. W., Yang, P. J., Lee, K. H., Hsu, C. W., & Tsai, I. T. (2017). Association of renal function and symptoms with mortality in star fruit (Averrhoa carambola) intoxication. Clinical Toxicology (Philadelphia, Pa.), 55(7), 624-628. https://doi.org/10.1080/15563650.2017.1314490
Chua CB, et al. Association of Renal Function and Symptoms With Mortality in Star Fruit (Averrhoa Carambola) Intoxication. Clin Toxicol (Phila). 2017;55(7):624-628. PubMed PMID: 28443386.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of renal function and symptoms with mortality in star fruit (Averrhoa carambola) intoxication. AU - Chua,Choon-Bing, AU - Sun,Cheuk-Kwan, AU - Tsui,Huan-Wen, AU - Yang,Po-Jen, AU - Lee,Kuo-Hsin, AU - Hsu,Chih-Wei, AU - Tsai,I-Ting, Y1 - 2017/04/26/ PY - 2017/4/27/pubmed PY - 2017/8/8/medline PY - 2017/4/27/entrez KW - Averrhoa carambola KW - Star fruit KW - neurotoxicity SP - 624 EP - 628 JF - Clinical toxicology (Philadelphia, Pa.) JO - Clin Toxicol (Phila) VL - 55 IS - 7 N2 - BACKGROUND: Star fruit (SF) is a commonly available fruit produced and eaten in tropical and subtropical countries. Since 1993, various reports have described neurotoxicity after eating SF, but this clinical condition remains unfamiliar. We aimed to describe this clinical entity, the role of renal dysfunction in this disorder, treatment strategies, and prognosis of patients with SF intoxication. METHODS: We conducted a search of PubMed and Google Scholar databases from 1993 to 2016. We included reports describing patients with a clear history of SF ingestion with acute symptoms. We described the demographic characteristics, reported SF intake, treatments used, and outcomes. RESULTS: We reviewed totally 126 patients (male:female = 1.5:1) from 33 articles with mean age 54.4 ± 11 (range: 30-84). The most common symptom was hiccups (65%), whereas confusion and seizure were the most common symptoms associated with mortality (42% and 61%, respectively). Pre-intoxication renal function also affected mortality. While there was no mortality in patients with normal renal function (NRF), the mortality of patients among reported cases with chronic renal insufficiency and end-stage renal disease undergoing dialysis were 36% and 27%, respectively. With the inclusion of patients reported to have NRF, the overall mortality was 24%. Consistently, the number of SF consumed was substantially higher in the patients with NRF than those with renal functional impairment. The most common treatment strategy was hemodialysis (59%). CONCLUSIONS: Patients with impaired renal function were at higher risks of SF intoxication. Severe neurologic symptoms mandate immediate medical intervention because of the association between their occurrence and high mortalities. Toxin removal through dialysis, rather than symptomatic relief, seems to be beneficial to patient survival. Early and continuous dialysis appears to alleviate severe symptoms and prevent symptom rebounds. SN - 1556-9519 UR - https://www.unboundmedicine.com/medline/citation/28443386/Association_of_renal_function_and_symptoms_with_mortality_in_star_fruit__Averrhoa_carambola__intoxication_ L2 - https://www.tandfonline.com/doi/full/10.1080/15563650.2017.1314490 DB - PRIME DP - Unbound Medicine ER -