Starfruit toxicity - Revision history

Rossdonaldson1 at 20:03, 3 February 2020

2020-02-03T20:03:12Z

← Revisión anterior		Revisión del 20:03 3 feb 2020
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	==Background==		==Background==
	[[File:Carambola Starfruit.jpg\|thumb\|Vertical, end view, and cross section of the ripe carambola.]]		[[File:Carambola Starfruit.jpg\|thumb\|Vertical, end view, and cross section of the ripe carambola "starfuit".]]
	*Starfruit (''Averrhoa carambola'') is a fruit native to Southeast Asia, but is also grown in South America, the Caribbean, Africa, and the United States		*Starfruit (''Averrhoa carambola'') is a fruit native to Southeast Asia, but is also grown in South America, the Caribbean, Africa, and the United States
	*Can be consumed raw or as juice, jam, pickles, and in cooked dishes		*Can be consumed raw or as juice, jam, pickles, and in cooked dishes

Rossdonaldson1: /* Background */

2020-02-03T19:20:26Z

Background

← Revisión anterior		Revisión del 19:20 3 feb 2020
Línea 1:		Línea 1:
	==Background==		==Background==
			[[File:Carambola Starfruit.jpg\|thumb\|Vertical, end view, and cross section of the ripe carambola.]]
	*Starfruit (''Averrhoa carambola'') is a fruit native to Southeast Asia, but is also grown in South America, the Caribbean, Africa, and the United States		*Starfruit (''Averrhoa carambola'') is a fruit native to Southeast Asia, but is also grown in South America, the Caribbean, Africa, and the United States
	*Can be consumed raw or as juice, jam, pickles, and in cooked dishes		*Can be consumed raw or as juice, jam, pickles, and in cooked dishes

Jfang: References added

2020-01-28T00:24:23Z

References added

← Revisión anterior		Revisión del 00:24 28 ene 2020
Línea 2:		Línea 2:
	*Starfruit (''Averrhoa carambola'') is a fruit native to Southeast Asia, but is also grown in South America, the Caribbean, Africa, and the United States		*Starfruit (''Averrhoa carambola'') is a fruit native to Southeast Asia, but is also grown in South America, the Caribbean, Africa, and the United States
	*Can be consumed raw or as juice, jam, pickles, and in cooked dishes		*Can be consumed raw or as juice, jam, pickles, and in cooked dishes
			*In traditional Chinese medicine, used to treat diabetes mellitus<ref name="Caramboxin">Garcia-Cairasco N. et al. Elucidating the neurotoxicity of the star fruit. Angewandte Chemie (International ed. in English). 2013;52(49):13067-70.</ref>

	===Mechanism of Toxicity===		===Mechanism of Toxicity===
	*Toxicity caused by two compounds, oxalic acid and caramboxin		*Toxicity caused by two compounds, oxalic acid and caramboxin
	**Oxalic acid, a vitamin C metabolite, can worsen renal function but does not cause neurotoxicity		**Oxalic acid, a vitamin C metabolite, can worsen renal function but does not cause neurotoxicity
	**Caramboxin, an amino acid neurotoxin, stimulates glutamate receptors, which leads to seizures		**Caramboxin, an amino acid neurotoxin, stimulates glutamate receptors, which leads to seizures<ref name="Caramboxin"/>
			*Raw fruit has high potassium content while juice does not<ref name="FatalUremic">Chang J. et al. Fatal outcome after ingestion of star fruit (Averrhoa carambola) in uremic patients. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2000;35(2):189-93.</ref>, however hyperkalemia not found in many patients<ref name="TsaiSeizure">Tsai M. et al. Status epilepticus induced by star fruit intoxication in patients with chronic renal disease. Seizure. 2005;14(7):521-5.</ref><ref name="WuHemoperfusion">Wu M. et al. Hemoperfusion as an effective alternative therapy for star fruit intoxication: A report of 2 cases. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2006;49(1).</ref>

	==Clinical Features==		==Clinical Features==
	*Symptoms of neurotoxicity may occur in patients with renal disease, even 1-2 fruits or small volumes of juice		*Wide range of non-specific symptoms<ref name="Caramboxin"/><ref name="FatalUremic"/><ref name="TsaiSeizure"/><ref name="WuHemoperfusion"/><ref name="StarfruitCKD">Oliveira de. et al. Why eating star fruit is prohibited for patients with chronic kidney disease? Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia. 2015;37(2):241-7.</ref><ref name="StarfruitAKI">Abeysekera R. et al. Star fruit toxicity: A cause of both acute kidney injury and chronic kidney disease: A report of two cases. BMC research notes. 2015;8.</ref><ref name="Presentation">Neto MM. et al. Star fruit: Simultaneous neurotoxic and nephrotoxic effects in people with previously normal renal function. 2009;2(6).</ref>
	**Case reports of AKI in patients with previously normal renal function who consumed large amounts (over 10 fruits or greater than 1 L of juice)		**Persistent hiccups - most frequent symptom
	*Persistent hiccups - most frequent symptom		**Confusion
	*Confusion		**Agitation
	*Agitation		**Muscle twitching
	*Muscle twitching		**Nausea
	*Nausea		**Vomiting
	*Vomiting		**Seizures - associated with poor prognosis<ref name="TsaiSeizure"/><ref name="NetoCases">Neto M. et al. Intoxication by star fruit (Averrhoa carambola) in 32 uraemic patients: Treatment and outcome. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2002;18(1):120-5.</ref>
	*Seizures - associated with poor prognosis		*Symptoms of neurotoxicity may occur in patients with renal disease, even 1-2 fruits or small volumes of juice<ref name="StarfruitCKD"/>
			**Case reports of AKI in patients with previously normal renal function who consumed large amounts (over 10 fruits or greater than 1 L of juice)<ref name="StarfruitCKD"/><ref name="StarfruitAKI"/><ref name="Presentation"/>

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Management==		==Management==
	*Mixed results with hemodialysis, with some studies reporting no improvement even with repeated hemodialysis		*Mixed results with hemodialysis, with some studies reporting no improvement even with repeated hemodialysis<ref name="FatalUremic"/><ref name="StarfruitCKD"/>
	*Case reports of rapid improvement with charcoal hemoperfusion		*Case reports of rapid improvement with charcoal hemoperfusion<ref name="WuHemoperfusion"/><ref>Chen L. et al. Chronic renal disease patients with severe star fruit poisoning: Hemoperfusion may be an effective alternative therapy. Clinical toxicology (Philadelphia, Pa.). 2005;43(3):197-9.</ref><ref>Chan C. et al. Star fruit intoxication successfully treated by charcoal haemoperfusion and intensive haemofiltration. Hong Kong medical journal = Xianggang yi xue za zhi. 2009;15(2):149-52.</ref><ref>Wu C. et al. Sustained low-efficiency daily diafiltration with hemoperfusion as a therapy for severe star fruit intoxication: A report of two cases. Renal failure. 2001;33(8):837-41.</ref>

	==Disposition==		==Disposition==
	*If seizing, admit for monitoring and further workup		*If seizing, admit for monitoring and further workup
	**One study showed mortality as high as 75% in seizing patients, 0.03% in patients without seizures		**One study showed mortality as high as 75% in seizing patients, 0.03% in patients without seizures<ref name="TsaiSeizure"/>

	==See Also==		==See Also==

Jfang: Updated "See Also" and Category

2020-01-27T23:43:28Z

Updated "See Also" and Category

← Revisión anterior		Revisión del 23:43 27 ene 2020
Línea 38:		Línea 38:
	*If seizing, admit for monitoring and further workup		*If seizing, admit for monitoring and further workup
	**One study showed mortality as high as 75% in seizing patients, 0.03% in patients without seizures		**One study showed mortality as high as 75% in seizing patients, 0.03% in patients without seizures

			==See Also==
			*[[Toxicology (Main)]]
			*[[Traditional chinese medicine toxicology]]

			==References==
			<references/>

			[[Category:Toxicology]]

Jfang: Created page with "==Background== Starfruit (''Averrhoa carambola'') is a fruit native to Southeast Asia, but is also grown in South America, the Caribbean, Africa, and the United States Can b..."

2020-01-24T00:02:48Z

Created page with "==Background== *Starfruit (''Averrhoa carambola'') is a fruit native to Southeast Asia, but is also grown in South America, the Caribbean, Africa, and the United States *Can b..."

Página nueva

==Background==
*Starfruit (''Averrhoa carambola'') is a fruit native to Southeast Asia, but is also grown in South America, the Caribbean, Africa, and the United States
*Can be consumed raw or as juice, jam, pickles, and in cooked dishes

===Mechanism of Toxicity===
*Toxicity caused by two compounds, oxalic acid and caramboxin
**Oxalic acid, a vitamin C metabolite, can worsen renal function but does not cause neurotoxicity
**Caramboxin, an amino acid neurotoxin, stimulates glutamate receptors, which leads to seizures

==Clinical Features==
*Symptoms of neurotoxicity may occur in patients with renal disease, even 1-2 fruits or small volumes of juice
**Case reports of AKI in patients with previously normal renal function who consumed large amounts (over 10 fruits or greater than 1 L of juice)
*Persistent hiccups - most frequent symptom
*Confusion
*Agitation
*Muscle twitching
*Nausea
*Vomiting
*Seizures - associated with poor prognosis

==Differential Diagnosis==
{{Seizure DDX}}

==Evaluation==
*CBC
*Chemistry
*LFTs
*CSF studies
*Urine toxicology
*CT Head without contrast
*EKG

==Management==
*Mixed results with hemodialysis, with some studies reporting no improvement even with repeated hemodialysis
*Case reports of rapid improvement with charcoal hemoperfusion

==Disposition==
*If seizing, admit for monitoring and further workup
**One study showed mortality as high as 75% in seizing patients, 0.03% in patients without seizures

Starfruit toxicity - Revision history

Rossdonaldson1 at 20:03, 3 February 2020

Rossdonaldson1: /* Background */

Jfang: References added

Jfang: Updated "See Also" and Category

Jfang: Created page with "==Background== *Starfruit (''Averrhoa carambola'') is a fruit native to Southeast Asia, but is also grown in South America, the Caribbean, Africa, and the United States *Can b..."

Jfang: Created page with "==Background== Starfruit (''Averrhoa carambola'') is a fruit native to Southeast Asia, but is also grown in South America, the Caribbean, Africa, and the United States Can b..."