1/4. fatal outcome after ingestion of star fruit (Averrhoa carambola) in uremic patients.Clinical outcome of dialysis patients after eating star fruit (Averrhoa carambola) varies, but it may be fatal. In the past 10 years, 20 such patients were treated in our hospital when they developed clinical symptoms after eating the fruit or drinking star fruit juice. Their initial presentations included sudden-onset limb numbness, muscle weakness, intractable hiccups, consciousness disturbance of various degrees, and seizure. No other major events that might be responsible for these symptoms could be identified. Eight patients died, including one patient with a serum creatinine level of 6.4 mg/dL who had not yet begun dialysis. The clinical manifestations of the survivors were similar to those who died except for consciousness disturbance and seizure. death occurred within 5 days despite emergent hemodialysis and intensive medical care. The survivors' symptoms usually became less severe after supportive treatment, and these patients subsequently recovered without obvious sequelae. The purpose of this article is to report that patients with renal failure who ingest star fruit may develop neurological symptoms and also run the risk for death in severe cases. mortality may also occur in patients with chronic renal failure not yet undergoing dialysis.- - - - - - - - - - ranking = 1keywords = fruit (Clic here for more details about this article) |
2/4. Intoxication by star fruit (Averrhoa carambola) in 32 uraemic patients: treatment and outcome.BACKGROUND: Clinical symptoms and outcomes of uraemic patients ingesting star fruit are quite variable and may progress to death. 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. methods: We studied a total of 32 uraemic patients who had ingested star fruit. Before the intoxication episodes, 20 patients were on regular haemodialysis, eight were on peritoneal dialysis and four were not yet undergoing dialysis. Two patients were analysed retrospectively from their charts, 17 were directly monitored by our clinic and 13 were referred by physicians from many areas throughout the country, allowing us to follow their outcome from a distance. Intoxicated patients were given different therapeutic approaches (haemodialysis, peritoneal dialysis and supportive treatment), and their outcomes were analysed. RESULTS: The most common symptoms were persistent and intractable hiccups in 30 patients (93.75%), vomiting in 22 (68.7%), variable degrees of disturbed consciousness (mental confusion, psychomotor agitation) in 21 (65.6%), decreased muscle power, limb numbness, paresis, insomnia and paresthesias in 13 (40.6%) and seizures in seven (21.8%). patients who were promptly treated with haemodialysis, including those with severe intoxication, recovered without sequelae. patients with severe intoxication who were not treated or treated with peritoneal dialysis did not survive. CONCLUSIONS: Haemodialysis, especially on a daily basis, is the ideal treatment for star fruit intoxication. In severe cases, continuous methods of replacement therapy may provide a superior initial procedure, since rebound effects are a common event. peritoneal dialysis is of no use as a treatment, especially when consciousness disorders ensue.- - - - - - - - - - ranking = 1keywords = fruit (Clic here for more details about this article) |
3/4. Star fruit intoxication in uraemic patients: case series and review of the literature.Star fruit, belonging to the Oxalidaceae family, species Averrhoa carambola, is a popular fruit among Orientals. There have been reports of hiccup, confusion, and occasional fatal outcomes in uraemic patients after ingestion of star fruit. An excitatory neurotoxin from star fruit has been implicated although the exact nature of this toxic substance has not been identified. A group of seven patients is described from the dialysis centres at Queen Mary and Tung Wah hospitals who developed symptoms including hiccup, confusion, vomiting, impaired consciousness, muscle twitching and hyperkalaemia shortly after ingestion of star fruit. Symptoms of most patients resolved after intensified dialysis or spontaneously, and no mortality was observed. The close temporal relationship of ingestion of star fruit and onset of symptoms strongly suggests the existence of a causal relationship between the two. It is recommended that uraemic patients should totally abstain from star fruit due to these rare but potentially fatal complications. The clinical manifestations of other reported series and current evidence for the possible candidate(s) of the neurotoxin are discussed.- - - - - - - - - - ranking = 1.375keywords = fruit (Clic here for more details about this article) |
4/4. Essential amino acids in the treatment of advanced uremia: twenty-two months' experience in a 5-year-old girl.The value of conservative treatment in a case of chronic advanced renal failure was investigated in a 5-year-old girl with congenital hypoplastic kidneys. Before treatment the patient was severely anorexic and her plasma urea nitrogen was 180 mg/100 ml. Protein restriction alone was fruitless. After a transitional period on total parenteral therapy the patient was put on a maintenance oral diet, where an energy-rich diet was supplemented with essential amino acids including histidine. plasma urea nitrogen dropped and stayed at about 50 mg/100 ml during the whole treatment in spite of a rising plasma creatinine from 10 to 24 mg/100 ml. The general condition of the patient normalized as she went into an anabolic state with weight gain and growth in height. The nitrogen balance studied in two different periods was positive. An acute attack of pancreatitis, secondary to hyperparathyroidism, ended the patient's life after 22 months of treatment.- - - - - - - - - - ranking = 0.125keywords = fruit (Clic here for more details about this article) |