Star fruit treatment

In 2000 Chang JM et al [5] reported 19 patients with renal failure under dialysis and one also with renal failure but in supportive treatment who after star fruit ingestion developed signs and symptoms of intoxication such as hiccups, mental confusion, paresis, muscular weakness and convulsions. Eight of those patients died (including the patient in supportive treatment)... 

Star fruit intoxication can be classified into three levels according to signs and symptoms that might provide a useful guideline for institution of proper treatment mild, moderate and severe (Table 2). 

Seven patients who were in supportive treatment (without need for dialysis) at the time of star fruit ingestion had rruld intoxication presenting hiccups or diarrhea. Six patients improved without dialysis. Time to improve was up to 24 hours in 4 patients, 5 days in another one, and there is no information in one patient. One patient improved after IPD (intermittent peritoneal dialysis) [13,14]. Peritoneal dialysis was not an efficient method of treatment although 1 patient with signs and symptoms of moderate intoxication and 2 with mild intoxication changed from CAPD to IPD (intermittent peritoneal dialysis) and improved [13]. Two patients that remained in CAPD also improved [7, 12]. In one case [13] patient presented diplopia that continued for 6 weeks after improvement of the acute intoxication episode. Patients with severe intoxication did not benefit from peritoneal dialysis treatment [13]. 

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]. 

In fhe case of patienfs, fhe only reporf in which the authors claim that star fruit intoxication induce brain lesions (in this case thalamic and cortical) is the one from Chan YL ef al [11]. Unfortimafely fhere is no neurological follow up of fhe evenfual neurological sequelae thaf patienfs who survive will display in fheir future hves after the treatment s rescue. 

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. Nephrol DialTranspI 2003 18 120-125. 

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