Mad Honey Poisoning Case Series Presenting With ECG Findings Including Atrioventricular Complete Block and Symptomatic Hypotension.

Betul Borku Uysal,Emrah Ozdemir,Mehmet Sami Islamoglu,Kanan Talibli,Mehmet Dokur

doi:10.7759/cureus.17165

Abstract

Plants belonging to the Ericaceae family, which grow endemically in some parts of the world, contain grayanotoxin, which causes fatal bradyarrhythmia and circulatory collapse. Mad honey, which comes from plants with grayanotoxin, has various uses, namely, as an aphrodisiac, as an alternative therapy for GI disorders such as peptic ulcer, dyspepsia, and gastritis, and as a treatment for hypertension. However, GI, neurological and cardiac side effects may arise from its ingestion due to the grayanotoxin contained by this type of honey. Cardiac rhythm disturbances, sinus bradycardia, and other life-threatening side effects can occur, especially atrioventricular (AV) block and nodal rhythms. In this article, we present five honey poisoning cases involving adults who were admitted to our ED. Notably, one of the patients was unresponsive to atropine, so a temporary pacemaker was inserted, after which the patient was moved to the coronary ICU. Meanwhile, the cardiac rhythm of the other cases returned to normal in the follow-up after atropine administration.

Highlights

Every year, incidents of honey poisoning occur all over the world due to a type of honey called ‘mad honey' in Turkey [1]
The reason for the poisoning is a compound called grayanotoxin, which can be found in the pollens, nectars, flowers, and leaves of numerous variants of rhododendron plants in the Ericaceae family [2]
We present five cases of mad honey poisoning admitted to our ER and briefly discuss the related literature

Summary

Introduction

Incidents of honey poisoning occur all over the world due to a type of honey called ‘mad honey' in Turkey [1]. Case 1: A 50-year-old male patient was admitted for emergency service with symptoms of hypotension, dizziness, and bradycardia due to honey poisoning. Case 2: A 60-year-old male patient was admitted to our service with symptoms of chest pain, hypotension, and bradycardia He was transferred to the coronary ICU due to the following: 120/70 tension, pulse of 55 beats per minute, 36°C body temperature, and 98 SpO2. The patient’s pulse reached 55 beats per minute following the IV administration of atropine He was discharged after undergoing monitoring for a certain period at the coronary ICU. His pulse was 84 beats per minute, and the tension was 102/65 mmHg. The patient was discharged after a certain period of monitoring with a suggestion for a follow-up (Figure 6). The patient was discharged after undergoing monitoring for a certain period for normal sinus rhythm

Discussion

Conclusions

Disclosures