Explanation:
Starfruit also known as carambola, is the fruit of the Averrhoa carambola tree. It has potent neurotoxicity in ESRD patients. Ingestion of 1-2 fruits was associated with the development of neurologic symptoms within hours, an overall 40% mortality, and 80% mortality in patients with altered mental status. Star fruit is a high source of oxalate. This explains the gastrointestinal symptoms due to the direct corrosive injury of oxalate in the digestive tract.
Even in people with previously normal renal function, large amounts of star fruit ingestion, or even ingestion of smaller amounts on an empty stomach, can cause AKI with CNS toxicity. The most likely sequence of events involves AKI from acute oxalate nephropathy followed by neurotoxic effects (mostly hiccups, AMS , seizure, coma) triggered by a putative star fruit neurotoxin (caramboxin) that accumulates in these patients due to renal failure. Star fruit has a neurotoxin called caramboxin, which has renal excretion and can pass through the blood-brain barrier. When renal function is abnormal there is an elevation of caramboxin in the central nervous system that results in neurological symptoms such as hiccups, paresis, seizure, coma and even death.The nephropathy induced by oxalate begins a few hours after ingestion . The mechanism by which tubular damage occurred is the obstruction of renal tubules by these crystals as well as apoptosis of the renal tubular epithelial cells..
Hemodialysis is recommended when neurological symptoms are present, since it is believed that caramboxin is dialyzable and may increase oxalate clearance, apart from the removal of uremic toxins. peritoneal dialysis has been shown to be of no benefit, especially in these type of patients and suspected poisoning patients may need to be switched to hemodialysis. Papayas, passion fruit, grape fruit are not associated with neurotoxicity in ESRD patients.
Reference
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198447/
