Star fruit poisoning is potentially life-threatening in patients with moderate chronic renal failure

Abstract

Star fruit intoxications have been reported mainly in uremic patients, leading to various degrees of neurological symptoms and potentially fatal outcomes. Nephrotoxicity has been reported in few patients with normal renal function or moderate chronic renal impairment (CRI). The present report describes clinical course, management, and outcome of six patients with moderate CRI admitted to ICU for severe star fruit intoxication. Over a 1-year period we observed six cases of star fruit intoxication. All but two patients were prospectively monitored. For each case we collected clinical characteristics, management, and outcome. On admission, all patients presented acute renal failure with underlying moderate CRI and required intubation for coma. The most common symptoms were hiccups, mental confusion, seizures, and coma. Status epilepticus was authenticated in three patients. Management consisted of several methods of renal replacement therapy (RRT) and supportive measures. Four patients survived without sequelae and two patients died. Severe star fruit intoxication can occur in patients with moderate CRI with a potentially fatal outcome. Prompt continuous RRT should be instituted.