Clinical presentation of oxalate crystal injuries and toxicity from plants

Ingestion of plant-derived oxalate crystals results in immediate pain, burning and swelling of the lips, mouth, tongue and throat. The swelling can cause hypersalivation, dysphagia, dysphonia and upper airway obstruction. Rarely, the symptoms can be life threatening.

Effects from large ingestions of starfruit or starfruit juice may be more severe than effects from ingestion of other plant-derived oxalate crystals, and include:

• gastrointestinal effects—vomiting, abdominal pain
• kidney effects—obstructive nephropathy, acute kidney injury
• central nervous system (CNS) effects—hiccups, insomnia, agitation, paraesthesiae, seizures, status epilepticus, stroke-like symptoms; CNS effects are thought to be oxalate-induced or due to another unknown neurotoxin.