Star Fruit, a Neglected but Serious Fruit Intoxicant in Chronic Renal Failure

Background. Star fruit is a fruit originating is Southeast Asia and readily available in Taiwan. Star fruit causes several symptoms in patients with chronic renal failure or end stage renal disease. The symptoms vary, and include insomnia, intractable hiccup, agitation, muscle weakness, confusion, conscious disturbance of various degrees, seizure and cardiorespiratory arrest. The various star fruit subspecies contain different toxins, and a powerful neurotoxin that is suspected to accumulate in blood, cross the blood-brain barrier in chronic renal failure patients, and eventually cause irreversible damage. Mothods. We investigated three patients who suffered from star fruit intoxication, with different renal function status, clinical presentations and outcomes, and response to different management. We studied the star fruit intoxication with electroencephalography, and treated with plasma exchange. Results. Star fruit intoxication cannot be treated effectively. Our case suggests plasma exchange is an effective treatment in status seizure, but not in conscious disturbance. Conclusions. This results require further study of effectiveness, timing, frequency, and dosage of plasma exchange in star fruit intoxication to confirm this conclusion. Star fruit intoxication is a neglected but serious fruit intoxication which is frequently observed in patients with chronic renal failure. Because no effective treatment is available now, patients, especially those who are newly diagnosed with chronic renal failure and end stage renal disease, must be warned not to take star fruit, even a small amount.

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