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Diffuse ecchymosis on the lower limbs.
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Introduction
The toxic effects of the ingestion of star fruit (Averrhoa carambola) in chronic kidney disease patients are well described in the literature. Recently, the compound caramboxin has been isolated, explaining the mechanisms of its neurotoxicity. Bilimbi fruit belongs to the family Oxalidaceae, Averrhoa bilimbi species, and exhibits simil...
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... orotracheal intubation. At physical examination, the patient was under sedation, had a Richmond Agita- tion Sedation Scale score of -3, was hemodynamically stable, with a blood pressure of 110/60 mm Hg, and a heart rate of 68 bpm. The patient also had some diffuse ecchymoses on the trunk and extremities, probably due to the trauma of seizures ( Fig. ...
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Background: The star fruit [ Averrhoa carambola L (Oxalidaceae)] is traditionally used in the treatment of many ailments in many countries. It possesses several pharmacological activities, including antioxidant and anti-inflammatory effects. However, it contains the neurotoxic caramboxin and its high content of oxalic acid limits its consumption by...
The considerably high incidence of cardiovascular disease in Indonesia has attracted scientists to investigate various plant and fruit extracts as preventive agents. Averrhoa bilimbi (AB) is rich in bioactive constituents that may be effective in preventing indicators of hypertension. This study evaluated the roles of AB extract in increasing serum...
Averrhoa carambola L. (A. carambola) is particularly well-known for its distinctive star-shaped fruit (Star fruit), cultivated in Southeast Asia, the Indian subcontinent, and northern and southern America. Historically, it has been used for a long time to cure many ailments, including vomiting, fever, arthralgia, cough, hypertension, hangovers, chr...
Aims: This work aimed to evaluate the antimicrobial activities of three different sources of wood vinegars obtained from pyrolysis of carambola (Averrhoa carambola), coconut shells (Cocos nucifera) and mango (Mangifera indica) and to identify their chemical composition. Methodology and results: Agar well diffusion technique was employed to assay th...
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... Averrhoa bilimbi and Averrhoa carambola (starfruit) belong to the family Oxalidaceae and share similar biochemical properties. 6 There are many reported cases of star fruit-induced oxalate nephrotoxicity in those with existing renal impairment. However, the oxalic acid content in star fruit is less than bilimbi (0.8-7.3 mg/g). 1 Simon et al reported a case of an elderly woman with CKD on dialysis who presented with intractable hiccups and altered sensorium following ingestion of both bilimbi and star fruit. ...
... 2 In 2017, Caetano et al described the case of a patient with CKD on dialysis who developed neurological symptoms after the ingestion of bilimbi fruit, similar to those related to star fruit ingestion. 6 Initially, it was thought the neurotoxicity was due to the high oxalate content of the fruit, but recent findings seem to suggest another neurotoxin, called caramboxin, as the responsible agent. Caramboxin is an amino acid analogue and is metabolised and excreted by the kidneys. ...
Bilimbi fruit is widely eaten in Malaysia. Rarely reported is its potential to cause acute kidney injury (AKI) in patients with prior normal renal function. The possible dangers of its consumption are still relatively unknown among many. This case highlights the importance of taking a thorough dietary history in patients with AKI. We also hope to increase awareness among healthcare professionals on the nephrotoxic and neurotoxic effects of bilimbi fruits.
... It is highly likely that the problem is under-recognized and underreported. Neurotoxicity following ingestion of Averrhoa bilimbi in a patient with end stage kidney failure has also been reported [4], albeit not as frequent as the neurotoxicity caused by its cousin, Averrhoa carambola (balimbing or star fruit) [5]. Symptoms of neurotoxicity include uncontrollable hiccups, mental confusion and seizures [4,5]. ...
... Neurotoxicity following ingestion of Averrhoa bilimbi in a patient with end stage kidney failure has also been reported [4], albeit not as frequent as the neurotoxicity caused by its cousin, Averrhoa carambola (balimbing or star fruit) [5]. Symptoms of neurotoxicity include uncontrollable hiccups, mental confusion and seizures [4,5]. Although majority of the reported cases of AKI recovered with conservative management, many required acute hemodialysis [6,7,8,9]. ...
Averrhoa bilimbi belongs to the Oxalidacea family of fruits. It was introduced from tropical America but is now pantropic and is cultivated in many Asian countries including the Philippines. Its nutritional and medicinal values are well known, however, due to its high oxalate content, excessive intake can lead to acute kidney injury (AKI). We report a case of AKI after ingestion of kamias (Averrhoa bilimbi) juice. Consent was granted by the patient to share her case with the intent of raising public awareness regarding the dangers of consuming high quantity of Averrhoa bilimbi fruit.
... Phenols have the ability as anti-inflammatory, anticoagulant, antioxidant and immune system enhancers (Arukwe et al., 2012). Interestingly, a research showed the toxicity of A. bilimbi in which the compound of caramboxin has been isolated, explaining the mechanisms of its neurotoxicity (Caetano et al., 2017). ...
Averrhoa bilimbi is one of the Indonesian indigenous plants containing phenolic and flavonoids which exhibit several ethnopharmacological effects i.e. antidiabetic, anti-microbial, anti-inflammatory, cytotoxic, anti-oxidant, antifertility, and antibacterial activities. However, the optimum solvent for extracting these compounds using percolation have not been reported, yet. This research was aimed to evaluate the various concentrations of ethanol solvents towards total phenolic (TPC) and total flavonoid content (TFC). Extraction was carried out using percolation technique with ethanol solvent ratio of 50%, 70%, and 96%. The phytochemical screening, thin layer chromatography, total flavonoids, and total phenolic levels were obtained from the concentrated extract. The TPC and TFC were determined using visible spectrophotometry method. Phytochemical screening study indicated that ethanolic extract contains classes of flavonoids, phenolic, alkaloid, saponins, and steroids. The TFC of ethanolic extract with 50%, 70%, and 96% solvent concentrations were investigated at 62.74, 64.81 and 59.1 mg RTE / g extract, respectively while the TPC were recorded as follows: 103.79; 119.47; 110.10 mg GAE / g extract. Hence, 70% ethanol were higher among others, and therefore remains as optimum solvent for the extraction of A. bilimbi leaves.
The literature on phytochemicals is awash with the therapeutic roles of plant‐derived compounds. It has to be said that the medicinal and pharmacological values of plants are more widely reported than their toxic counterparts. In this chapter, emphasis is given to the phytochemical agents that produce toxic effects in the central and peripheral nervous systems. The nervous systems are pivotal to the functionality of virtually all systems in the human body. The blood–brain barrier provides a route through which drugs and other small molecules find their way to the most intricate computational networks of the brain. Most importantly, the molecular mechanisms of toxicity involve alterations to the signaling pathways by a number of biochemical processes. In this chapter, we present the chemical hallmarks of phytotoxins, detailing their molecular neurotoxicity concomitantly with the mechanisms underlying their inherent poisoning effects.
Rahmawati N, Mustofa FI, Haryanti S. 2020. Diversity of medicinal plants utilized by To Manui ethnic of Central Sulawesi, Indonesia. Biodiversitas 21: 375-392. The present study reports the utilization of medicinal plants as medicines for the treatment of various diseases among the people of To Manui tribe in Central Sulawesi Province of Indonesia. Data collecting was conducted based on purposive random sampling to five selected traditional healers who fulfilled some inclusion criteria. The results showed as of 89 species of medicinal plants distributed in 50 families and 80 genera have been documented to have any pharmacological effects against 37 diseases and illnesses. Curcuma longa L. was determined as the most frequent medicinal plant used by traditional healers in To Manui for treating diabetes mellitus as well as after-birth treatment. However, conservation of some medicinal plants needs to be initiated in the study area especially Alstonia scholaris (L.) R. Br. as it is recognized in International Union for Conservation of Nature (IUCN) Red List as Least Concern (LC) of conservation status.
