Death associated with ingestion of starfruit (Averrhoa carambola) in a patient with chronic kidney disease

We detail a case of a 74-year-old female with a history of chronic kidney disease (CKD) and diabetes mellitus (DM) who initially presented to the Emergency Department (ED) with intractable hiccups after ingesting two whole starfruit (SF) and quickly became critically ill while in the ED. Our patient was admitted and received several rounds of hemodialysis, but efforts proved futile, as the patient expired during her hospital course. To the best of our knowledge, this is the first fatality reported due to SF ingestion in the U.S, and highlights the need for both a better understanding of SF intoxication and clearer guidelines and timing for treatment. Due to the increased mortality of patients who consume SF with a medical history of CKD or DM, it is prudent that Emergency Physicians are familiar with the clinical presentation and management options for SF toxicity. (C) 2023 Elsevier Inc. All rights reserved.

Automated summary

This case report describes a 74-year-old female with chronic kidney disease and diabetes mellitus who developed intractable hiccups and deteriorated rapidly after consuming starfruit. Despite receiving multiple rounds of hemodialysis, the patient did not survive. This is the first reported fatality due to starfruit ingestion in the U.S., highlighting the need for better understanding and guidelines for the treatment of starfruit toxicity.