POISONOUS PARTS
Fruits.4,5
TOXICITY
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Toxic Constituents
Unknown neurotoxin and oxalate.4–7
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Toxic Dose
Half of a star fruit can cause neurological symptoms in renal failure patients. Ingestion of 1600 mL sour star fruit juice has been reported to cause acute oxalate nephropathy.8,9
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Mechanism
Unknown for the neurotoxin. Formation of calcium oxalate crystals in renal tubules occurs with excessive consumption of oxalate, resulting in acute tubular necrosis.4,5,7,9
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Poisoning Features
Renal failure patients can develop hiccups, vomiting, insomnia, agitation, limb numbness and paraesthesia, deteriorated renal function, confusion, convulsion, coma and even death. Excessive use in healthy subjects may rarely cause nausea, vomiting, abdominal pain, acute oxalate nephropathy and renal failure.8–11
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Poisoning Events
Multiple cases of star fruit poisoning in renal failure patients have been reported worldwide. Acute oxalate nephropathy was reported in 2 men in Taiwan after taking more than 1600 mL sour star fruit juice, and they recovered uneventfully after treatment.4,5,8–12
CLINICAL MANAGEMENT
Supportive treatment and intensification of dialysis. Early initiation of charcoal haemoperfusion has also been suggested for severe poisoning.5
IDENTIFICATION FEATURES
Small evergreen trees, 5–8 m tall; bark sometimes rimous. Leaves odd-pinnate, 8–18 cm long, with 5–11 alternate or subopposite leaflets, terminal leaflets largest, leaflets near the base of peduncle gradually smaller; leaflets 3–8 × 2–3.5 cm. Panicles 2.5–5 cm long, grown on the trunks and branches. Fruits 7–15 cm long, (3–)5(or 6)-ribbed, transverse section stellate.13
MEDICINAL USES
Uses in TCM—fruits: clear heat, engender fluid, induce diuresis, remove toxin; flowers: control malaria, relieve pain, remove toxin, kill parasites; leaves: dispel wind and drain dampness, induce diuresis, disperse heat and toxin, relieve pain. Recommended dose: fruits 30–60 g, flowers 9–30 g, leaves 15–30 g.3,14
LABORATORY ANALYSIS
Oxalate can be detected by HPLC-DAD and GC-MS.15–16
