Star fruit neurotoxicity

Fang HC, Chen CL, Lee PT, Hsu CY, Tseng CJ, Lu PJ, Lai SL, Chung HM, Chou KJ.The role oif oxalate in star fruit neurotoxicity of Five-sixths nephrectomized rats. Food Chem Toxicol 2007 45 1746-1749. 

Hemoperfusion was used for the first time as an option of treatment in a severe case by Chen LL et al [18] and patient consciousness returned to normal without subsequent mental confusion. Wu MY et al [19] submitted 2 patients with severe intoxication to 20 hours and 8 hours of hemoperfusion and also had good and fast improvement of the intoxication condition. In this 3 cases, 2 hemodialysis sessions in the first described patient, 1 hemodialysis session and 2 daily hemodialysis session in the patients of the second report failed to counterbalance neurotoxicity however consciousness improved dramatically after hemoperfusion [19]. A dramatic decrease in comatose time and rapid weaning from the ventilator may help reduce morbidity and mortality [19]. Hemoperfusion seems to be a promising kind of treatment to severe cases of star fruit intoxication. However this issue requires further analysis with large trials [19]. 

Despite the recent reports of neurotoxicity of star fruit in uremic patients, the first one on star fruit toxicity was described by Muir and Lam [27] in 1980. They related toxic effects of star fruit extract after its intraperitoneal administration in mice. This extract induced seizures and death. In 1993, Martin LC et al. reported the outcome of intractable hiccups in uremic patients associated to star fruit consume [3]. However, the first report of neurotoxicity in human beings was performed by Moyses-Neto M et al (4). Subsequently, many similar case reports were described, but only in 2002 an etiological agent was proposed oxalic acid would be the star fruit neurotoxin [28]. 

Wu ON, Deng JC, Tsai WS, Lin SH. Star fruit-induced neurotoxicity in two patients with chronic renal failure. J Med Sci 2002 22(2). 

Wang YCL, Liu BM, Supernaw RB, Lu YH, Lee PY. Management of star fruit-induced neurotoxicity and seizures in a patient with chronic renal failure. Pharmacotherapy 2006 26 143-146... 

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