Search

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.

Plant exposures constitute the 4th most common call to poison information centers. Within the plant category, exposures to unidentified berries are common and often create panic in the public and indecisiveness by health professionals. Are exposures to unidentified berries associated with morbidity and mortality? Can these berry exposures be managed at home or do they necessitate medical evaluation? The AAPCC Toxic Exposure Surveillance System was queried to identify exposures with the "unidentified berry" code for a 10-y period. Data parameters included frequency, age, outcome, patient disposition, referral pattern, symptom progression and therapeutic intervention. The data were analyzed using descriptive statistics. Unidentified berry exposures included 11,237 incidents, making it the 11th most common plant-related exposure. Children < 6 y-of-age accounted for 88.5% of the exposures, and 88.5% occurred during June-October. There were no fatalities, and morbidity included 1 major outcome in an infant and 26 exposures with moderate outcomes. In exposures with a known outcome, no effects (86.0%) and minor effects (13.6%) accounted for 99.6% of exposures. When a patient was initially asymptomatic, 89.7% did not develop symptoms and 10.2% progressed to have minor symptoms, accounting for 99.9% of all exposures. Poison centers referred 7.5% to a health care facility. There was no apparent benefit conferred by decontamination therapy. Exposures to unidentified berries represent common inquiries to poison information centers. They are associated with low morbidity and no mortality. If no initial symptoms are present, it is unlikely that the patient will develop clinically relevant effects.