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Carotenemia caused by durian

A few patients presented to my clinic here in Sipitang, Sabah complaining of yellowish discolouration of their palm and soles. One of them is a contractor, deny any exposure to chemical and paint or even plant that can cause the contamination and discoloration of palm and sole. That patient claimed his cousin, brother and sister also having the same problem. It all happen within this few days to weeks. It occur suddenly, when it occur it is so obvious that their palms and soles were yellow in colour. Otherwise their sclera is normal.

There is also an old lady complain of the same thing. She also did not have yellowish discoloration of the sclera. Her palm and soles completely turn to yellow.

I have ordered liver function test for all patient ehich turn out to be normal. Their bilirubin leven did not raised.

Its a carotenemia from what I have learn in medical school. The first thing I ask them when I suspect this is " have you eaten a lot of carrot or tamato juice at home. Or eating any particular vegetable or fruit in excessive amount?"

All of them answered me which lead me to make a conclusion. All of them ate a lot of Durian in the last few weeks.

Durian is a seasonal fruit in Malaysia. Particularly in Sipitang, this district is a major supplier of this exotic fruit in a west coast of Sabah. Durian was everywhere in the last few weeks.

I've make a little research and found out that this fruit contain a high amount of vitamin A. It is so rich in carotene. From the sources that I found, it contain 150mg of vitamin A in 100g of serving compare to 23mg vit C per 100 g. This fruit is a source of vitamin A.

This can lead to what is happening here in Sipitang when suddenly a lot of people presented with Carotenemia.

Plus, the durian which is craved here is a version of Durian which is not sweet but have a nutty taste. They call it Durian kuning. The pulp is almost red if not orange in colour. I do not know the scientific name for this type of durian thus I could not find any nutritional fact of it. But from my observation, the red colour could be caused by a high carotene content inside it.

Carotenemia can persist up to 5 months in a patient even though their vitamin A level is already normal. It is a benign condition and do not have significant effect on health.

I would very interested if someone can provide me the real amount of vitamin A in this red durian/ orange durian/ durian kuning. I strongly believe that this is what cause Carotenemia here in Sipitang, Sabah.

More study should be conducted.


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