Star Fruits (Averrhoa carambola); Persistent Hiccups and Severe Metabolic Acidosis in An End-Stage Renal Disease Patient
Keywords:
Star Fruits, End-Stage Renal Disease Patient, Persistent HiccupsAbstract
We encountered a man in his 70’s with end-stage renal disease (ESRD) who experienced a persistent hiccup. The hiccup was unresponsive to various standard medications, including metoclopramide, chlorpromazine, baclofen, and phenytoin. The patient developed dyspnea due to severe lactic acidosis 7 hours later. After ruling out possible causes of the persistent hiccups and lactic acidosis, a toxicologist discovered that the patient had taken four star fruits 4 hours before the onset of the symptoms.
References
Neto MM, da Costa JAC, Garcia-Cairasco N, Netto JC, Nakagawa B, Dantas M. Intoxication by star fruit (Averrhoa carambola) in 32 uraemic patients: treatment and outcome. Nephrol Dial Transplant. 2003;18(1):120-125. doi:10.1093/ndt/18.1.120
Garcia-Cairasco N, Moyses-Neto M, Del Vecchio F, et al. Elucidating the Neurotoxicity of the Star Fruit. Angewandte Chemie International Edition. 2013;52(49):13067-13070. doi:10.1002/anie.201305382
Yamamoto R, Morita S, Aoki H, Nakagawa Y, Yamamoto I, Inokuchi S. Acute renal failure and metabolic acidosis due to oxalic acid intoxication: a case report. Tokai J Exp Clin Med. 2011;36(4):116-119.
Wijayaratne DR, Bavanthan V, de Silva MVC, Nazar ALM, Wijewickrama ES. Star fruit nephrotoxicity: a case series and literature review. BMC Nephrol. 2018;19(1):288. doi:10.1186/s12882-018-1084-1
Chua CB, Sun CK, Tsui HW, et al. Association of renal function and symptoms with mortality in star fruit (Averrhoa carambola) intoxication. Clin Toxicol (Phila). 2017;55(7): 624-628. doi:10.1080/15563650.2017.13144 90
Cheungpasitporn W, Zand L, Dillon JJ, Qian Q, Leung N. Lactate clearance and metabolic aspects of continuous highvolume hemofiltration. Clin Kidney J. 2015;8(4):374-377. doi:10.1093/ckj/sfv045
Cruz MD, Ershad M, Mostafa A. Metabolic Acidosis and Hyperlactatemia Requiring Continuous Venovenous Hemofiltration after Intentional Ingestion of Metformin. Indian J Nephrol. 2021;31(1):77-78. doi:10.4103/ijn.IJN_117_19
Aranguren C, Vergara C, Rosselli D. Toxicity of star fruit (Averrhoa carambola) in renal patients: A systematic review of the literature. Saudi J Kidney Dis Transpl. 2017;28(4):709-715.
Fernandez-Prado R, Esteras R, Perez-Gomez MV, et al. Nutrients Turned into Toxins: Microbiota Modulation of Nutrient Properties in Chronic Kidney Disease. Nutrients. 2017;9(5):E489. doi:10.3390/nu9050489
Stumpf MAM, Schuinski AFM, Baroni G, Ramthun M. Acute Kidney Injury with Neurological Features: Beware of the Star Fruit and its Caramboxin. Indian J Nephrol. 2020;30(1):42-46. doi:10.4103/ijn.IJN_53_19
Barman AK, Goel R, Sharma M, Mahanta PJ. Acute kidney injury associated with ingestion of star fruit: Acute oxalate nephropathy. Indian J Nephrol. 2016;26(6):446-448. doi:10.4103/0971-4065.175978
Jonassen JA, Cao LC, Honeyman T, Scheid CR. Mechanisms mediating oxalate-induced alterations in renal cell functions. Crit Rev Eukaryot Gene Expr. 2003;13(1):55-72. doi:10.1615/critreveukaryotgeneexpr.v13.i1.50
Pillai U, Hothi JC, Bhat ZY. Severe propylene glycol toxicity secondary to use of antiepileptics. Am J Ther. 2014;21(4):e106-109. doi:10.1097/MJT.0b013e31824c407d
Miller MA, Forni A, Yogaratnam D. Propylene glycol-induced lactic acidosis in a patient receiving continuous infusion pentobarbital. Ann Pharmacother. 2008;42(10):1502-1506. doi:10.1345/aph.1L186
Golden TR, Solnicky V, Wadeea R, Ghazala S. Pentobarbital-induced lactic acidosis following status epilepticus barbiturate coma. BMJ Case Rep. 2018;2018:bcr-2017-223482. doi:10.1136/bcr-2017-223482
Downloads
Published
How to Cite
License
Copyright (c) 2024 Thai Collage of Emergency Physicians
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
บทความที่ได้รับตีพิมพ์ในวารสารเวชศาสตร์ฉุกเฉินแห่งประเทศไทย ถือเป็นเป็นลิขสิทธิ์ของ วิทยาลัยแพทย์เวชศาสตร์ฉุกเฉินแห่งประเทศไทย
กรณีที่บทความได้รับการตีพิมพ์ในวารสารเวชศาสตร์ฉุกเฉินแห่งประเทศไทยแล้ว จะตีพิมพ์ในรูปแบบอิเล็กทรอนิกส์ ไม่มีสำเนาการพิมพ์ภายหลังหนังสือเผยแพร่เรียบร้อยแล้ว ผู้นิพนธ์ไม่สามารถนำบทความดังกล่าวไปนำเสนอหรือตีพิมพ์ในรูปแบบใดๆ ที่อื่นได้ หากมิได้รับคำอนุญาตจากวารสารเวชศาสตร์ฉุกเฉินแห่งประเทศไทย
