Star fruit: simultaneous neurotoxic and nephrotoxic effects in people with previously normal renal function

Patients with renal failure not yet on dialysis (stages 3–5) or on dialysis treatment are susceptible to intoxication from eating star fruit (Figure ​(Figure1).1). In these patients, star fruit may cause mild to severe neurotoxicity including hiccups, vomiting, asthenia, mental confusion, seizures, coma and death [1–3]. However, there are anecdotal reports of individuals with normal renal function who became intoxicated as a result of eating or drinking a large amount of star fruit, and intractable and persistent hiccups are usually the main symptom. Fig. 1 Star fruit (Averrhoa carambola) or carambola has been cultivated in Malaysia, Southern China, Taiwan, India and Brazil. It is rather popular in the Philippines and Queensland, Australia and moderately so in some of the South Pacific Islands, particularly ... Star fruit nephrotoxicity in people with normal renal function is rarely reported and it is never associated with signs of neurotoxicity. There is only prior one study of such cases, which reported on two cases of acute renal failure (ARF) due to acute oxalate nephropathy in patients with previous normal renal function [4]. In the current study, we present five patients with previously normal renal function who became intoxicated from eating star fruit or drinking star fruit juice and presented simultaneously nephrotoxic and neurotoxic effects.