Acute Kidney Injury with Neurological Features: Beware of the Star Fruit and its Caramboxin.

Star fruit (Averrhoa carambola) is a well-known product in tropical countries. There are few reports published in literature with acute kidney injury due to oxalate induced nephropathy. However, none of them have an important neurological feature. We present a case of a 51-year-old male with paresis and altered mental status. Screening for neurological diseases such as stroke, Guillain-Barre, meningitis and encephalitis were negative. In the evolution, he developed acute kidney failure and was submitted to 4 dialysis sessions. After talking to the family, we discovered he had ingested over 50 star fruits prior to the acute neurologic deficits. He recovered renal function so a renal biopsy was not required. Physicians should actively look for star fruit ingestion history in patients presenting with unexplained acute kidney injury with or without neurological features. Besides, taking star fruit in a large amount, accompanied by an empty stomach and dehydrated state, is a risk factor for neurotoxicity.

Hypernatremia secondary to post-stroke hypodipsia: just add water!

Disorders in water metabolism may occur in stroke patients. When hypernatremia arises in this setting, it is usually secondary to the development of central diabetes insipidus or it is the result of neurologic lesions that prevent patients from having free access to water. Much rarer are the cases of post-stroke hypernatremia caused by hypodipsia secondary to lesions of the thirst center. We report the case of a patient with severe hypernatremia, probably secondary to post-hemorrhagic stroke hypodipsia. The hypernatremia seen in this case was corrected by scheduling the patient's water intake.