Star fruit: The Death Fruit for Dialysis Patients

By Peter Laird, MD

Dialysis patients limit potassium, phosphorus and salt and are advised to eat several servings of fruits and vegetables, but their is one fruit that should never find its way onto your menus. The star fruit is a popular fruit especially in the Philippines and the south Pacific and it is now becoming a popular fruit in America as well. However, for dialysis patients, the star fruit could be deadly.

Intoxication by star fruit (Averrhoa carambola) in 32 ueaemic patients:

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.

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.

Daily hemodialysis is the only effective treatment for star fruit intoxication, but the best treatment alternative for this neurotoxic fruit is to simply avoid it completely. My Filipino wife enjoys this fruit but won't bring it into the house at all since it is a potentially deadly toxin to me. Just one small price we pay for extending our lives with dialysis. The star fruit is one fruit to scratch from your diet and not temp yourself at any time. Testing the limits of this neurotoxic fruit is not advisable if you are on dialysis or have chronic kidney disease. Fortunately, I wasn't that adventuresome when I visited the Philippines several years ago before I was aware of the deadly consequences. For once, my simple tastes turned out to be my best friend.

Comments

[George]

Thanks. I am a nephrologist, and knew this info, but I don't think many patients do.

I like you blog, lot of details about dialysis and up to date.

[Peter Laird, MD]

Thank you George, please comment freely as I am sure that there is much for all of us to discuss and comment about as we all try to reach a consensus on how to improve the plight of the American dialysis patient.

[Roberta Mikles BA RN]

When my father was a patient we never knew this and found out strictly by accident. I was very surprised because at our unit there were alot of Asian and Phillipino patients, as well as staff. My point being that I wondered how many patients, familiar with this fruit, would eat it and then become ill
In fact, the dietician was from the Phillipines, if I recall. I wonder why patients are not informed of this ---pretty scarey, but does not surprise me
Roberta Mikles www.qualitysafepatientcare.com