Fallo renal cronico

Intensive Care Med (2009) 35:1459–1463 DOI 10.1007/s00134-009-1490-8

BRIEF REPORT

Alexandre Herbland Ibrahim El Zein Ruddy Valentino Christophe Cassinotto ´ Cecile Meunier Denise Rieux Hossein Mehdaoui

Star fruit poisoning is potentially life-threatening in patients with moderate chronic renal failure

Abstract Purpose: Star fruit intoxications have been reported mainly in uremicpatients, leading to various degrees of neurological symptoms and potentially fatal outcomes. Nephrotoxicity has been reported in few patients with normal renal function or moderate chronic A. Herbland ()) Á I. El Zein Á renal impairment (CRI). The present R. Valentino Á C. Meunier Á report describes clinical course, D. Rieux Á H. Mehdaoui management, and outcome of six Intensive Care Unit,University Hospital of patients with moderate CRI admitted Fort de France, 97200 Fort de France, to ICU for severe star fruit intoxicaMartinique, French West Indies, France tion. Methods: Over a 1-year period e-mail: alexandre.herbland@orange.fr Tel.: ?33-6-37815257 we observed six cases of star fruit Fax: ?33-4-72110110 intoxication. All but two patients were prospectively monitored. For C. Cassinottoeach case we collected clinical charDepartment of Radiology, acteristics, management, and University Hospital of Fort de France, outcome. Results: On admission, all 97200 Fort de France, Martinique, patients presented acute renal failure French West Indies, France
Received: 9 December 2008 Accepted: 27 March 2009 Published online: 10 April 2009 Ó Springer-Verlag 2009

with underlying moderateCRI and required intubation for coma. The most common symptoms were hiccups, mental confusion, seizures, and coma. Status epilepticus was authenticated in three patients. Management consisted of several methods of renal replacement therapy (RRT) and supportive measures. Four patients survived without sequelae and two patients died. Conclusions: Severe star fruit intoxication can occur in patientswith moderate CRI with a potentially fatal outcome. Prompt continuous RRT should be instituted. Keywords Star fruit Á Averrhoa carambola Á Intoxication Á Neurotoxicity Á Nephrotoxicity Á Oxalate

Introduction
Star fruit (SF) (Averrhoa carambola, Oxalidaceae family) is a tropical fruit originating from Asia, grown in many other tropical or subtropical zones. SF is now easily available worldwide,particularly in Western markets in Europe or in North America. Since the first publication on SF toxicity in 1980 [1], nephrologists from tropical countries have described in great detail SF neurotoxicity in uremic patients [2–8]. A wide range of symptoms exists but seizures and status epilepticus potentially lead intoxicated patients to ICU and are associated with poor prognosis [2–4]. Few casesof SF intoxication concern patients with mild chronic renal impairment (CRI) [9], and nephrotoxicity has rarely been reported [8, 10]. The

susceptibility of such patients to SF and the severity of intoxication are poorly known by intensivists and have never been reported in critical care journals. The aim of this article is to describe the clinical features, management, and outcome of sixpatients with moderate CRI admitted to our ICU for severe SF intoxication.

Patients and methods
From September 2006 to September 2007 we observed six cases of SF intoxication. Two patients were analyzed retrospectively and four were prospectively monitored in our unit. For each case we collected the following data:

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past medical history, etiology and degree of underlying CRI, usualmedications, IGS II score, duration of symptoms before admission to ICU, clinical and laboratory parameters on admission and during ICU stay, treatments administrated in ICU, length of stay, and outcome. This study was performed with approval from our Institutional Review Board. Informed consent was obtained from all patients or their parents.

Results
Patients’ characteristics The patients’...