In fact, less than one ounce (half of a starfruit) is enough to make your dog ill because of the soluble calcium oxalate it contains. Starfruit neurotoxicity mimicking an acute brainstem stroke. Star fruit intoxication is a rare cause of consciousness disturbance in patients with renal failure. Just something to think about, before you reach for the stars. People with healthy, normal kidneys can process and pass this toxin out from their body. We present a patient with chronic renal failure, who was not on dialysis program yet, suffered from star fruit intoxication with presentation of consciousness disturbance and successfully managed by a session of hemodialysis. We’ve known for more than a quarter century now about the neurotoxic effects, but few seem to be familiar with the syndrome. Below is an approximation of this video’s audio content. Peritoneal dialysis is of no use as a treatment, especially when consciousness disorders ensue. Carambola, also known as starfruit, is the fruit of Averrhoa carambola, a species of tree native to tropical Southeast Asia. 2018;19(1):288. Some features of the site may not work correctly. (Preliminary report). It starts, most commonly, with hiccups, but then can rapidly worsen, especially in those with compromised kidney function to start out with. Alessio-Alves FF, De Souza CP, Da Silva LK, Moyses-Neto M, Pontes-Neto OM. Someone walks into the ER with intractable hiccups. Most cases in the literature are uremic patients on maintenance dialysis. Studies show that eating starfruit can have a harmful (toxic) effect for people who have kidney disease. Star fruit ingestion may cause renal impairment through its nephrotoxic effects. They all have had issues with their kidneys and thus should never eat star fruit. Caramboxin: Patients suffering from chronic kidney disease are frequently intoxicated after ingesting star fruit. Video includes graphics from Vecteezy.com. If you haven’t yet, you can subscribe to my videos for free by clicking here. The main symptoms of this intoxication are named in the picture. Another potential mechanism for mental confusion, coma and seizures following star fruit intoxication in chronic kidney disease patients, may be due to a worsening of the pre-existing renal impairment causing uraemic encephalopathy. The fruit contains a neurotoxin that healthy kidneys can filter out, but damaged kidneys are unable to do so. (2003) who studied the intoxication in 32 uraemic patients found those who were promptly treated with hemodialysis (HD), recovered without sequelae; those who were untreated or treated with other form of dialysis, peritoneal dialysis (PD), unfortunately did not survive. Intractable Hiccups Induced by Carambola(Averrhoa Carambola) Ingestion in Patient with End Stage Renal Failure, Heart & lung : the journal of critical care, American journal of kidney diseases : the official journal of the National Kidney Foundation, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, View 4 excerpts, references background and methods, By clicking accept or continuing to use the site, you agree to the terms outlined in our. Chua CB, Sun CK, Tsui HW, et al. Severe neurologic symptoms mandate immediate medical intervention because of the … Star fruits are an excellent source of vitamin C, is low fat, and naturally sodium and cholesterol free. Star fruit intoxication is a rare cause of consciousness disturbance in patients with renal failure. Peritoneal dialysis is of no use as a treatment, especially when consciousness disorders ensue. Interestingly, Neto et al. In my video cautioning about oxalate-rich foods, I talked about star fruit nephrotoxicity—kidney toxicity. 2013;52(49):13067-70. 2009;38(3):1-3. Fatal Outcome after Star Fruit (Averrhoa Carambola) Ingestion in Patient with Chronic Renal Insufficiency, Star Fruit Intoxication in Chronic Kidney Disease: Our Experience, Chronic Renal Disease Patients with Severe Star Fruit Poisoning: Hemoperfusion May Be an Effective Alternative Therapy, Fatal Outcome After Ingestion of Star Fruit in a Severe Chronic Kidney Disease Patient. A small whole star fruit will provide approximately 2/3 cup sliced. 2017 Dec;21(6):635-637. doi: 10.1111/1744-9987.12588. By subscribing, you will automatically receive the latest videos emailed to you or downloaded to your computer or portable device. @article{Chen2010StarFI, title={Star fruit intoxication in a patient with moderate renal insufficiency presents as a posterior reversible encephalopathy syndrome. Patients with renal failure not yet on dialysis (stages 3–5) or on dialysis treatment are susceptible to intoxication from eating star fruit (Figure 1). However, there are anecdotal reports of individuals with normal renal function who became intoxicated as a result of eating or drinking a large amount of star fruit, and intractable and persistent hiccups are u… Star fruit intoxication is a rare cause of consciousness disturbance in patients with renal failure. https://nutritionfacts.org/video/neurotoxicity-effects-of-star-fruit Hemoperfusion as an effective alternative therapy for star fruit intoxication: a report of 2 cases. J Nephrol. Clin Neurol Neurosurg. Niticharoenpong K, Chalermsanyakorn P, Panvichian R, Kitiyakara C. Acute deterioration of renal function induced by star fruit ingestion in a patient with chronic kidney disease. Most cases in the literature are uremic patients on maintenance dialysis. Anti-Cancer Fruit. In Brazil, where the fruit is popular, there are actually laws to alert people about the risks. Internal Medicine Journal, 2003, 33:314-316 14- Neto MM, Costa JAC, Garcia –Cairasco N, Netto JC, Nakagawa B, Dantas M. Intoxication by star fruit ( averrhoa carambola ) in 32 uraemic patients: treatment and outcome. In a series of about a hundred cases of toxicity, consumption ranged between just a half of a star fruit up to 50, with an average of about four, but most of those had some sort of pre-existing kidney disease. The video I mentioned is Kidney Stones and Spinach, Chard, and Beet Greens Don’t Eat Too Much, which is the follow-up to Oxalates in Spinach and Kidney Stones: Should We Be Concerned? The Carambola tree has a lifespan of 40 years and reaches a height of 7–10 m (22–33 ft), spreading 6–7.6 m (20–25 ft) in … 2017;55(7):624-628. We present a patient with chronic renal failure, who was not on dialysis program yet, suffered from star fruit intoxication with presentation of consciousness disturbance and successfully managed by a session of hemodialysis. Putting star fruit or carambola on the menu would be downright dangerous. If any changes are made to the original text or video, you must indicate, reasonably, what has changed about the article or video. Or subscribe with your favorite app by using the address below: To subscribe, select the "Subscribe on iTunes" button above. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. But what about the neurotoxicity? Background: Star fruit (SF) is a commonly available fruit produced and eaten in tropical and subtropical countries. 2015;37(4):429-30. Elucidating the neurotoxicity of the star fruit. You may not apply legal terms or technological measures that restrict others from doing anything permitted here. Fatal outcome after ingestion of star fruit (Averrhoa carambola) in uremic patients. Garcia-Cairasco N, Moyses-Neto M, Del Vecchio F, et al. Most cases in the literature are uremic patients on maintenance dialysis. Star Fruit poisoning in dogs is a serious condition that can cause acute kidney injury even if eaten in small amounts. ↑ Chan C. et al. 2012;114(6):684-5. Copy the address found in the box above and paste into your favorite podcast application or news reader. Star fruit poisoning is potentially life-threatening in patients with moderate chronic renal failure, Sustained Low-Efficiency Daily Diafiltration with Hemoperfusion as a Therapy for Severe Star Fruit Intoxication: A Report of Two Cases, Intoxication by star fruit (Averrhoa carambola) in six dialysis patients? Editorial Star fruit intoxication in chronic kidney disease patients: from the first clinical description to caramboxin. J Bras Nefrol. BMC Nephrol. Clin Toxicol (Phila). Pasqual Barretti. Because the “fruit contains a powerful neurotoxin that can accumulate in blood, cross the blood–brain barrier…, and eventually cause irreversible [brain] damage.” The toxin itself, named caramboxin, is normally excreted by the kidneys; and so, is especially toxic to those with renal insufficiency—compromised kidney function—so much so that for those with severe chronic kidney disease, a single star fruit can put someone in seizures within three hours, a coma, and then death within three days. I would like to highlight a less common but important cause of AKI associated with star fruit nephrotoxicity. [6] Acute oxalate nephropathy associated with ingestion of star fruit (carambola) has been reported. Epub 2017 Oct 16. Intoxication by star fruit (Averrhoa carambola) in six dialysis patients? Star Fruit Intoxication in a Patient Undergoing Regular Hemodialysis Ther Apher Dial. You may not use our material for commercial purposes. Semantic Scholar is a free, AI-powered research tool for scientific literature, based at the Allen Institute for AI. Because of the neurotoxins, star fruit should be prohibited for patients with chronic kidney disease, and even those with normal kidney function may want to avoid the fruit. METHODS: We studied a total of 32 uraemic patients who had ingested star fruit. If you have any questions, please Contact Us. The tree is cultivated throughout tropical areas of the world. Star fruit nephrotoxicity: a case series and literature review. Severe encephalopathy after ingestion of star fruit juice in a patient with chronic renal failure admitted to the intensive care unit. The average number of star fruits eaten by the normal kidney function group before their toxic dose was more like 15. Star fruit contains a neurotoxin that affects the brain and nerves but which people with healthy kidneys are able to filter out; it therefore poses no danger to those whose kidneys function normally. De Oliveira ES, De Aguiar AS. Image has been modified. In these patients, star fruit may cause mild to severe neurotoxicity including hiccups, vomiting, asthenia, mental confusion, seizures, coma and death [1–3]. Star fruit contains a neurotoxin known as caramboxin that can cause irreversible brain damage at high enough doses. J Bras Nefrol. Select the subscription method below that best fits your lifestyle. In severe cases, continuous methods of replacement therapy may provide a superior initial procedure, since rebound effects are a common event. 2009;15(2):149-52. The fruit is commonly consumed throughout Southeast Asia, the South Pacific, Micronesia, parts of East Asia, and the Caribbean. 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. CONCLUSIONS: Haemodialysis, especially on a daily basis, is the ideal treatment for star fruit intoxication. The clinical symptoms recovered and the brain lesion reversed after emergency hemodialysis. Fatal Outcome After Ingestion of Star Fruit in a Severe Chronic Kidney Disease Patient. One of the questions the emergency room physician should ask is, “Have you been eating star fruit?”. Toxicity is affected by the type of star fruit preparation as well as patient hydration and the fasting/ feeding state. Association of renal function and symptoms with mortality in star fruit (Averrhoa carambola) intoxication Patients with impaired renal function were at higher risks of SF intoxication. You must attribute the article to NutritionFacts.org with a link back to our website in your republication. Tsai JT, F TC, Wang CH, Chung TH, Hsu BG. There have been reports of hiccup, confusion, and occasional fatal outcomes in uraemic patients after ingestion of star fruit. Heart Lung. You may republish this material online or in print under our Creative Commons licence. Star fruit: simultaneous neurotoxic and nephrotoxic effects in people with previously normal renal function. To bookmark this site, press the Ctrl + D keys on your Windows keyboard, or Command + D for Mac. Neto MM, Robl F, Netto JC. This toxic substance is called a neurotoxin. The experience of the Italian Collaborative DIA-QOL (Dialysis-Quality of Life) Group. Star fruit intoxication was first described in 1980 by Munir and Lam,(3) in Malaysia, where the fruit was observed to cause central nervous system depressive ef-fect. Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0), Kidney Stones and Spinach, Chard, and Beet Greens Don’t Eat Too Much. Star fruit intoxication in uraemic patients: case series and review of the literature. This fruit contains a substance that is a deadly neurotoxin for people with … Angew Chem Int Ed Engl. Most cases in the literature are uremic patients on maintenance dialysis. Star fruit intoxication successfully treated by charcoal haemoperfusion and intensive haemofiltration. In severe cases, continuous methods of replacement therapy may provide a superior initial procedure, since rebound effects are a common event. 4. For some older videos I did on kidney stones, see How to Prevent Kidney Stones with Diet and How to Treat Kidney Stones with Diet. Since 1993, various reports have described neurotoxicity after eating SF, but this clinical condition remains unfamiliar. Wijayaratne DR, Bavanthan V, De Silva MVC, Nazar ALM, Wijewickrama ES. Nephrol Dial Transplant. Hong Kong medical journal = Xianggang yi xue za zhi. Star fruit intoxication is a rare cause of consciousness disturbance in patients with renal failure. You are currently offline. The bottom line is that those with chronic kidney disease should avoid star fruit to avoid severe intoxication. Why? Bioguided chemical procedures resulted in the discovery of caramboxin, which is a phenylalanine‐like molecule that is responsible for intoxication. Most cases in the literature are uremic patients on maintenance dialysis. Why eating star fruit is prohibited for patients with chronic kidney disease? 2009;2(6):485-8. CONCLUSION: The clinicians should be aware that star fruit intoxication must be considered when patients with a chronic renal disease, even mild or moderate chronic renal insufficiency, present with unexplained neurological or psychiatric symptoms. “…[E]xcessive consumption of star fruit has been associated with the development of oxalate [kidney damage].” Less than a cup of star fruit juice or three whole fruits—they’re not that big—can result in “acute star fruit nephrotoxicity.” “…[I]ngestion of even modest quantities of star fruits can produce” kidney problems;  so, it is essential to educate the public to avoid consuming star fruit, “especially on an empty stomach or in a dehydrated state” to prevent star fruit nephrotoxicity. Barretti P. Star fruit intoxication in chronic kidney disease patients: from the first clinical description to caramboxin. Go to a hospital if you experience symptoms of "star fruit intoxication" after consuming the fruit. 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