June 7, 2011

The Deadly Star fruit to the Patient with Chronic Renal Failure

image taken from this site [link]

Star fruits or its scientific name Averrhoa carambola is a very common fruit in our local setting. It is delicious either to be eaten raw, blended to make juice or cook as food.

To the normal people, it is a bless from heaven especially during the hot day where the star fruit juice is a perfect company. However, it will create disaster and even causing death to the patient with renal problem.

It is because, once eaten, the star fruit will release neurotoxin to the blood stream, substance rich in high oxalic acid content and also contains high level of potassium. To normal people, all of this will be safely excreted through the kidney.

The neurotoxin effect will cause from a range of mild to severe effect to the chronic renal failure patient. Mild symptoms would include hiccups, vomiting and insomnia while the severe intoxication may lead to severe mental confusions, coma, seizure progressing to status epilepticus and haemodynamically instability which may lead to hypotension and shock.

Meanwhile the oxalic acid will precipitate the formation of kidney stone, hence worsening the renal functions.

Therefore, it is recommended that the patient with chronic renal failure should abstain themselves from eaten this deadly fruit. Apart from that, history of eating the star fruit should be elicit in chronic renal failure patient who presented with fast progressing altered consciousness or other neurological manifestations.


1. Auxiliadora-Martins M, Alkmin Teixeira GC, da Silva GS, et al, "Severe encephalopathy after ingestion of star fruit juice in a patient with chronic renal failure admitted to the intensive care unit.", Heart Lung. 2010 Sep-Oct;39(5):448-52. Epub 2009 Dec 11

2. Chang JM, Hwang SJ, Kuo HT, et al, "Fatal outcome after ingestion of star fruit (Averrhoa carambola) in uremic patients.", Am J Kidney Dis. 2000 Feb;35(2):189-93.

3. Chen LL, Fang JT, Lin JL, "Chronic renal disease patients with severe star fruit poisoning: hemoperfusion may be an effective alternative therapy.", Clin Toxicol (Phila). 2005;43(3):197-9.

4. Herbland A, El Zein I, Valentino R et al, "Star fruit poisoning is potentially life-threatening in patients with moderate chronic renal failure.", Intensive Care Med. 2009 Aug;35(8):1459-63. Epub 2009 Apr 10.

5. Tsai MH, Chang WN, Lui CC, et al, "Status epilepticus induced by star fruit intoxication in patients with chronic renal disease.", Seizure. 2005 Oct;14(7):521-5. Epub 2005 Oct 5.

6. Wang YC, Liu BM, Supernaw RB, Lu YH, Lee PY., "Management of star fruit-induced neurotoxicity and seizures in a patient with chronic renal failure.", Pharmacotherapy. 2006 Jan;26(1):143-6.


  1. mak ai.. cam xcaye. hehe.
    nice post bro!

  2. byk benda yg kita x buat research atau sebenarnya dah ada tp kita x tau.. contohnya nenas sbg weak labour induction agent, grapefruit potentiate the effect of antihypertensive medicine bla bla bla..so rajin2 kan check evidence based medicine

  3. hehe. nenas tu saye tahu laa. sebab asal ade orang ngandong tapi tamaw anak jek, mesti sebok nak makan nenas. tapi anggur tu taktahu pulak. yg saye tahu. elok makan sekali ngan bijik die sebab it act as antioxidant. betol tak dr naim? (whoaa DOKTOR tu) hehe

  4. grapefruit tu bukan anggur dik oi... bendalah tu buah limau yg isi dia warna merah... x byk jual kat mesia..byk kat oversea

  5. thanks for your lovely sharing.

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  6. ouh, so it is important to ask that. But I always hesitate to mention any consumption of herbal medicine or healthcare supplements which I have heard may precipitate certain disease like kidney stone or the such in my case presentation. Maybe because I did not do much reading on the effect of those stuffs in relation to nephrotoxicity or hepatotoxicity, so dont have the gut to include it in my case. haha

    btw, I'm Key, 3rd year IIUM medical student currently in my second posting of clinical years (loooooong way to go -_-), surgery. Have been reading your notes on OnG last time which were very helpful. one of it even came out as my long case. haha. May Allah bless you doctor.


Ya Allah! Permudahkanlah aku untuk menuntut ilmuMu, memahaminya, mengingati dan menyebarkannya. Berkatilah ilmu itu dan tambahkanlah ia. Amin.