826: THE LAND OF MILK, HONEY, AND . . . GRAYANOTOXIN???!!

Abstract

Introduction: Grayanotoxins, also known as andromedotoxin, acetylandromedol or rhodotoxin, are derived from the plants belonging to genera of the Ericaceae (heath) family. The toxin binds to the group II receptor site in voltage-gated sodium channels and produces a continued action of vagal stimulation resulting in decreased blood pressure and decreased heart rate. Due to this action, some cultures consume this toxin intentionally for medical benefits. Rarely does this intoxication lead to death in humans. Description: Our patient was a 49-year-old female with no past medical history who presented to the emergency department a sudden onset of nausea, vomiting, and intermittent hypotension. The patient had recently traveled to her home country of Nepal. Upon her return, she had nasal congestion decided to make tea. To sweeten the tea, she added honey that she had bought while abroad. Shortly after ingesting the honey, her symptoms began. Her husband, who also had the honey at the same time, experienced similar symptoms. Initially, she was bradycardic to the fifties for EMS but in the sixties on arrival to the ER. She was significantly hypotensive in emergency department, which responded to 2 liters of intravenous fluids. Her nausea and vomiting had ceased with antiemetics, and the rest of her physical examination was normal. Due to the co-ingestion of the honey and emergence of symptoms, poison control was called and attributed these symptoms to “Mad Honey Syndrome,” a grayanotoxin toxicity that can occur from wild honeys is select regions, including Nepal. Discussion: This care highlights the continued need to take complete histories on our patients including all medications taken, both prescribed and not prescribed. For critical care providers, our differential diagnosis of shock grows by the day and makes this diagnosis even more difficult to make at times. Ultimately the patients’ symptoms abated, and both husband and wife were discharged home.