Chua Choon-Bing, Sun Cheuk-Kwan, Tsui Huan-Wen, Yang Po-Jen, Lee Kuo-Hsin, Hsu Chih-Wei, Tsai I-Ting
a Department of Emergency Medicine , E-Da Hospital, I-Shou University , Kaohsiung City , Taiwan.
b Department of Neurology , E-Da Hospital, I-Shou University , Kaohsiung City , Taiwan.
Clin Toxicol (Phila). 2017 Aug;55(7):624-628. doi: 10.1080/15563650.2017.1314490. Epub 2017 Apr 26.
Star fruit (SF) is a commonly available fruit produced and eaten in tropical and subtropical countries. Since 1993, various reports have described neurotoxicity after eating SF, but this clinical condition remains unfamiliar. We aimed to describe this clinical entity, the role of renal dysfunction in this disorder, treatment strategies, and prognosis of patients with SF intoxication.
We conducted a search of PubMed and Google Scholar databases from 1993 to 2016. We included reports describing patients with a clear history of SF ingestion with acute symptoms. We described the demographic characteristics, reported SF intake, treatments used, and outcomes.
We reviewed totally 126 patients (male:female = 1.5:1) from 33 articles with mean age 54.4 ± 11 (range: 30-84). The most common symptom was hiccups (65%), whereas confusion and seizure were the most common symptoms associated with mortality (42% and 61%, respectively). Pre-intoxication renal function also affected mortality. While there was no mortality in patients with normal renal function (NRF), the mortality of patients among reported cases with chronic renal insufficiency and end-stage renal disease undergoing dialysis were 36% and 27%, respectively. With the inclusion of patients reported to have NRF, the overall mortality was 24%. Consistently, the number of SF consumed was substantially higher in the patients with NRF than those with renal functional impairment. The most common treatment strategy was hemodialysis (59%).
Patients with impaired renal function were at higher risks of SF intoxication. Severe neurologic symptoms mandate immediate medical intervention because of the association between their occurrence and high mortalities. Toxin removal through dialysis, rather than symptomatic relief, seems to be beneficial to patient survival. Early and continuous dialysis appears to alleviate severe symptoms and prevent symptom rebounds.
杨桃是热带和亚热带国家常见的一种水果，人们既生产也食用它。自1993年以来，已有多份报告描述了食用杨桃后的神经毒性，但这种临床病症仍不为人所熟知。我们旨在描述这一临床病症、肾功能不全在该病症中的作用、治疗策略以及杨桃中毒患者的预后情况。
我们检索了1993年至2016年的PubMed和谷歌学术数据库。我们纳入了描述有明确食用杨桃史且出现急性症状患者的报告。我们描述了患者的人口统计学特征、报告的杨桃摄入量、所采用的治疗方法以及治疗结果。
我们共回顾了33篇文章中的126例患者（男性与女性比例为1.5:1），平均年龄为54.4±11岁（范围：30 - 84岁）。最常见的症状是打嗝（65%），而意识模糊和癫痫是与死亡率相关的最常见症状（分别为42%和61%）。中毒前的肾功能也会影响死亡率。肾功能正常（NRF）的患者无死亡病例，而报告病例中慢性肾功能不全和接受透析的终末期肾病患者的死亡率分别为36%和27%。纳入肾功能正常的患者后，总体死亡率为24%。同样，肾功能正常的患者食用杨桃的数量显著高于肾功能受损的患者。最常见的治疗策略是血液透析（59%）。
肾功能受损的患者杨桃中毒风险更高。严重的神经系统症状因其与高死亡率相关，所以需要立即进行医学干预。通过透析清除毒素而非缓解症状，似乎对患者生存有益。早期和持续透析似乎可减轻严重症状并防止症状反弹。
