Mad Honey Poisoning Research Articles

Mad honey (wild honey) poisoning: clinical case series from Nepal.

Mad honey is commonly used for hypertension, and coronary artery disease, and as a sexual stimulant. Patients with mad honey poisoning present with dizziness, nausea, syncope, blurred vision, bradycardia, and hypotension with ECG findings of sinus bradycardia, complete AV block, and ST elevation. Here, the authors report five cases admitted to our tertiary care center following the consumption of mad honey. The amount of ingestion of honey varies from 1 to 2 teaspoons (~10-20ml). Most of the cases presented with chief complaints of nausea, dizziness, and vomiting, and all the cases had hypotension and bradycardia. Two cases were admitted to the ward and three of them were admitted to the ICU for further management. They were managed with intravenous fluid, injection atropine along with adjunctive vasopressor and oxygen whenever necessary. Mad honey contains grayanotoxin extracted from the nectar of Rhododendron species. This honey contains grayanotoxin, which binds to sodium channels in its open state causing hyperpolarization of the sodium channel predominantly causing gastrointestinal, neurological, and respiratory symptoms. Intravenous fluids and injection atropine are the mainstays of management in an ICU setup. Some also may require vasopressors. Mad honey poisoning is rare, and limited cases have been reported in Nepal. Physicians should consider mad honey poisoning in cases with ingestion history and clinical symptoms, as it may be a clinical diagnosis due to limited lab tests for grayanotoxin intoxication. Supportive management still forms the cornerstone for its management after diagnosis.

Anaphylactic shock following the mad honey consumption: a case report

Introduction: Mad honey consumption is a common practice in Nepal for medicinal and consumption purposes, but it can lead to severe adverse effects. Grayanotoxin I and Grayanotoxin III isoforms found in rhododendron interfere with voltage-gated sodium channels resulting in gastrointestinal symptoms, and cardiovascular effects such as low blood pressure, abnormal heart rhythms, cardiac arrest, and abnormal electrical conduction in the heart, as well as rare central nervous system disorders. Here the authors report a case of Mad honey consumption leading to anaphylactic shock along with its investigations and management. Case presentation: The authors present a case of a 51-year-old female who developed anaphylactic shock after consuming mad honey. The patient experienced symptoms including nausea, vomiting, abdominal pain, sweating, dizziness, facial and lip swelling, but no chest pain, loss of consciousness, abnormal body movement, or dyspnoea. The patient had no prior medical conditions, regular medications, or history of allergic reactions to honey or pollen. Discussion: Mad honey intoxication is caused by grayanotoxins, with distinct cardiac effects for different types of grayanotoxins. Symptoms include bradycardia, hypotension, abdominal pain, dizziness, and nausea, which subsided within 24 h following the initial management. The presence of grayanotoxin can be detected using specialized instrumentation, but it may not be available in all medical facilities. Co-intoxication with alcohol or propolis may also occur. Conclusion: This case highlights the importance of recognizing and managing complications associated with mad honey consumption, particularly in regions where it is prevalent. Prompt medical attention is advised if unusual symptoms occur after honey consumption.

Mad honey poisoning presenting with syncopal attack: a case report.

The authors report a case of 62 years old male with mad honey poisoning who was presented to the emergency department with loss of consciousness and had bradycardia and hypotension on arrival. The patient received intravenous fluids, atropine, and vasopressor support and was closely monitored in the coronary care unit for 48h. Grayanotoxin I and II are believed to be primarily responsible for mad honey intoxication and act by persistent activation of voltage-gated sodium channels. Hypotension, dizziness, nausea, vomiting, and impaired consciousness are the common presentation of mad honey intoxication. Toxic effects are usually mild and close monitoring for 24-48h is sufficient but life-threatening complications like cardiac asystole, convulsions, and myocardial infarction have also been reported. Most cases of mad honey intoxication only need symptomatic treatment and close observation but the potential for deterioration and life-threatening complications must also be considered.

Management of mad honey intoxication with suspected anaphylaxis in Nepal: a case report.

The authors reported the case of a middle-aged male patient who presented with blurring of vision, passage of loose stools, vomiting, and profuse sweating after ingestion of honey. He also had a history of loss of consciousness. On presentation, he was hypotensive and tachypneic with cold, clammy extremities. His ECG showed sinus bradycardia. The authors made a diagnosis of mad honey intoxication with suspected anaphylaxis. The authors treated him with intravenous normal saline, epinephrine, and atropine. He again developed hypotension and bradycardia in a few hours, for which hydrocortisone was administered, following which his heart rate was normalized in 2h. Overall, the recovery time in our patient was 8h. The patient was counseled to avoid consuming mad honey and did well on his monthly follow-up. Our patient had signs and symptoms suggesting intoxication following ingestion of mad honey with suspicion of anaphylaxis. Similar to other reported cases, the patient had sinus bradycardia and hypotension. Epinephrine and atropine were administered to treat hypotension and bradycardia, respectively. Also, refractory hypotension was managed by intravenous hydrocortisone. Usually, atropine and saline infusion are sufficient to manage these cases, and simultaneous use of epinephrine and atropine should be avoided unless indicated. Our case highlighted the approach to diagnosing and treating mad honey intoxication with suspected anaphylaxis.

Worldwide distribution and clinical characteristics of mad honey poisoning cases.

Mad honey poisoning is a common public health problem that can be seen in many parts of the world. In this study, the symptoms and clinical findings of mad honey poisoning cases and their distribution worldwide were investigated based on current data. PubMed, Scopus, Web of Science and Google Scholar databases were searched. The demographic characteristics of the cases, clinical findings, amount of consumed honey, duration of hospitalization, and data of the region where mad honey was produced were recorded. 900 cases were identified. The majority of poisoning cases (91.44%) were reported from mad honey produced in Turkey, Nepal (4.67%) came second and Korea (1.56) third. The majority of cases in Turkey were due to honey produced in the Black Sea Region. It was also determined that the mad honey was produced in the west Black Sea Region in most of the cases (35.22%), followed by the east Black Sea Region with a rate of 33.22%. In poisonous cases, it was determined that the mad honey was mostly produced in Rize, followed by Trabzon and Kastamonu, respectively. The most common signs of mad honey poisoning were bradycardia (88.48%) and hypotension (76.04%). The majority of cases have been reported from Turkey. When examining where the mad honey was produced in Turkey, it was seen that the western Black Sea Region came first, and the eastern Black Sea Region came second. Rize came first among the provinces, followed by Trabzon and Kastamonu. There is a parallelism between the distribution of mad honey poisoning cases and the distribution areas of Rhododendron species. However, although Rhododendron species show a widespread distribution throughout the world, why the majority of the cases were reported from Turkey draws attention as an issue that needs to be investigated.

Clinical Presentation, Electrocardiographic Findings, and Factors Related to the Hospitalization In Mad-Honey Intoxication.

ObjectivesMad-honey intoxication (MHI) often presents with all kinds of bradyarrhythmias. Despite numerous publications focused on clinical findings, we aim to evaluate poor prognostic implications, ischemia likely electrocardiography (ECG) changes, and detailed ECG findings of MHI in the largest series.MethodsThis is a retrospective single-center study of 117 MHI patients admitted to emergency service.ResultsThe study had 26 (22.2%) females (median 52.5 years) and 91 (77.8%) males (median 51.0 years). Fifty-six (47.9%) patients had ischemia likely changes on ECG. Multivariate model demonstrated that beta-blocker usage (odds ratio (OR): 52.871; 95% confidence interval (CI): 3.618-772.554 (p=0.004)), atrioventricular junctional rhythm (AVJR) (OR: 5.319; 95%CI: 1.090-25.949 (p=0.039)), and quantity of mad-honey consumption (OR: 1.035; 95% CI: 1.008-1.063 (p=0.011)) are predictors of hospitalization. ROC curve analysis showed cutoff value of mad-honey consumption quantity 24.79 g had 57% sensitivity and 68% specificity for predicting hospitalization (AUC: 0.7, 95% CI: 0.55-0.816, p=0.027). In addition, all hospitalized cases were male.ConclusionOur study has shown that male gender, AVJR, the quantity of mad-honey consumption, and beta-blocker usage are high-risk criteria for hospitalization in MHI patients. Furthermore, ischemia likely ECG changes is often observed with MHI even independently from hypotension or bradycardia.

Evaluation of Electrocardiographic Parameters and the Presence of Interatrial Block in Patients with Mad Honey Intoxication.

Mad honey intoxication (MHI) is a food-induced clinical condition that usually presents with cardiovascular symptoms and can lead to life-threatening arrhythmias if not diagnosed and treated early. No data exist in the literature on the presence of interatrial block (IAB) after food intoxication. In our study, we sought to investigate atrioventricular electrocardiography (ECG) parameters and determine the frequency of IAB in patients with MHI. In total, 76 patients diagnosed with MHI were included in our retrospective study. Twelve-lead ECGs were performed and participants were divided into two groups according to the presence of IAB in the reference ECG. The P maximum (Pmax), P minimum (Pmin), P dispersion (Pdisp), T peak to T end (Tp-Te) interval and QT dispersion (QTdisp) values were compared between the two groups. IAB was detected in 28 (35.5%) of 76 MHI patients included in the final analysis. Pmax duration (122 ± 8; p < 0.001) and PD (69 ± 11; p < 0.001) were significantly higher in the IAB ( +) group. During regression analysis, Pmax [odds ratio (OR) 1.158, 95% confidence interval (CI) 1.036-1.294; p = 0.010] and Pd (OR 1.086, 95% CI 1.001-1.017; p = 0.046) were independently associated with IAB. Pmax and Pd area under the receiver operating characteristic curve values for IAB prediction were 0.926 (95% CI 0.841-1,000; p < 0.001) and 0.872 (95% CI 0.765-0.974; p < 0.001), respectively. ECG changes are common in patients presenting with MHI. These patients need to be followed up clinically in terms of progression to arrhythmic events that may occur in the future.

IS EMERGENCY ROOM OBSERVATION SUFFICIENT FOR MAD HONEY POISONING? A CASE REPORT

Grayanotoxin poisoning is most commonly seen in the East Black Sea Region of Turkey due to consumption of mad honey, which is made by bees from the flowers of the rhododendron plant. Mad honey poisoning is dose dependent. In low doses, it causes dizziness, hypotension and bradycardia. In high doses, it can cause unconsciousness, seizures and atrioventricular blocks. Local people are well aware of mad honey poisoning and generally do not go to the hospital for mild symptoms. In clinical practice, patients with mad honey poisoning are kept under coronary intensive care observation for at least 12-24 hours. As seen in this case report as well as in some publications in the literature, stable patients who respond to atropine and fluid therapy may not need to be hospitalized. In this case report, we present a patient with sinus bradycardia due to mad honey poisoning from the East Black Sea Region of Turkey, who responded to intravenous fluid and atropine treatment in a short time.

Deli bal zehirlenmesinde klinik özellikler ve laboratuar bulguları: Retrospektif bir çalışma

Deli bal zehirlenmesinde klinik özellikler ve laboratuar bulguları: Retrospektif bir çalışma

Cardiovascular collapse due to wild honey Intoxication: A case report

Background: Wild honey has been traditionally been used by indigenous people for its medicinal, aphrodisiac and hallucinogenic properties in Nepal and some other countries. Wild (mad) honey intoxication is one of the rarest presentations to emergency department and is caused by ingestion of wild honey obtained from the nectar of Rhododendron species on the higher altitudes. The cause of mad honey poisoning is the toxin grayanotoxin, found in such wild honey. It can also be caused by consuming the leaves, flowers of Rhododendron from Himalayan belt. Wild honey intoxication has widely been reported from Turkey and the regions around the Black Sea. Some cases have been reported in the few hospitals in Kathmandu and Chitwan. However, such cases have rarely been reported in eastern Nepal. The intoxication might present with mild symptoms of gastrointestinal, cardiovascular and neurological systems or might also present in rare life threatening form with AV block and cardiovascular collapse. Here, we report a case of a seventy three years old man who presented to our emergency department with cardiovascular collapse in the form of severe bradycardia, AV block and hypotension after wild honey consumption.Health Renaissance 2015;13(2): 170-172

Grayanotoxin levels in blood, urine and honey and their association with clinical status in patients with mad honey intoxication

ObjectivesThe purpose of this study was to investigate whether there is an association between grayanotoxin levels in urine and blood of patients with mad honey intoxication and in the honey consumed, and the resulting clinical picture. The pilot data acquired from this study was analysed in National Forensic Service, Daejeon Institute, South Korea and first results were published as a preliminary study. Patients and methodsThis descriptive study was conducted at a university hospital emergency department in Turkey. 25 cases diagnosed with mad honey intoxication were obtained the study. Samples of mad honey consumed by patients were obtained. Blood and urine specimens were collected at presentation to the emergency department. GTX 1 and GTX 3 levels from patients' blood, urine and honey consumed were investigated simultaneously using the LC-MS/MS system. ResultsMean GTX 1 concentration in blood was 4.82 ng/mL and mean GTX 3 level 6.56 ng/mL. Mean GTX concentration in urine was 0.036 μg/mL and mean GTX 3 level 0.391 μg/mL. Mean GTX I concentration in honeys consumed was 8.73 μg/gr and mean GTX 3 level 27.60 μg/gr. ConclusionThis descriptive study is show grayanotoxin levels in body fluids of patients with mad honey intoxication. No association was determined between grayanotoxin levels in blood and clinical data.

Mad Honey-Related Intoxication in an Infant: A Case Report

Introduction: The nutraceutical value and ingredients of honey make it attractive for complementary and alternative medicine. Herein, we report a case of mad honey intoxication in an infant following the ingestion of honey for an intractable cough.Case Report: A 5-month-old male infant was given two teaspoons of honey by his mother with his breakfast for coughing for the past 2 days. Four hours later following ingestion, he started to vomit and became drowsy. On arrival at the emergency department, he was drowsy and his Glasgow Coma Scale score was 10. With respect to systemic examination, abdominal sonography, performed to exclude any intraabdominal and renal pathology, revealed no pathology. Urine examination revealed proteins and hemoglobin. He was not given any other treatment except fluid replacement. At the fifth hour of arrival, his symptoms and physical examination findings all resolved. He was thought to have honey poisoning and was admitted to the pediatric clinic for follow-up.Conclusion: Mad honey is a natural product, but because of its ability to cause allergic reactions in susceptible people, honey should not be given to infants younger than 1 year. Intoxication should be considered in emergency department patients in the eastern Black Sea region of Turkey. Although not clearly established, there might be nephrotoxic effects in human beings

A rare case of Kounis syndrome provoked by mad honey poisoning

Kounis syndrome, resulting in acute coronary syndromes, as a result of allergic or hypersensitivity reaction is triggered by several factors. Vasospasm which is mediated by mediators released after mast cell activation, is the responsible mechanism for comprising of type 2-myocardial infarction. Mad honey containing grayanotoxin is previously shown to be associated with gastrointestinal, neurological and cardiac disorders. In this case report, we presented a Kounis syndrome that has occurred after the mad honey intake and treated successfully, previously not mentioned in the literature.

Episodic Left Bundle Branch Block-A Comprehensive Review of the Literature.

Episodic (transient/ intermittent) left bundle branch block (LBBB) has been associated with different conditions such as bradycardia, tachycardia, anesthesia, acute pulmonary embolism, changes in intrathoracic pressure, chest trauma, cardiac interventional procedures, mad honey poisoning, and in other clinical settings. Of note, exclusion of an acute coronary syndrome in the setting of episodic LBBB is of great importance. Moreover, episodic LBBB is sometimes symptomatic and may be associated with left ventricular systolic and/or diastolic dysfunction or conduction disturbances leading to syncope. This review article provides a comprehensive overview of the conditions associated with episodic LBBB and discusses the clinical impact of this phenomenon.

Mad Honey Poisoning Associated with Hypotension and Bradycardia in the Late Period: Case Report

Mad Honey Poisoning Associated with Hypotension and Bradycardia in the Late Period: Case Report

Mad Honey Poisoning–Related Hypothermia: A Case Series

BackgroundMad honey–related intoxication frequently leads to bradycardia, hypotension, and syncope. Hypothermia is a potentially life-threatening condition if not identified early and treated appropriately. Case ReportThree patients are reviewed. Patient 1 was a 66-year-old man who presented to the emergency department with nausea, vomiting, and faintness beginning 2 h after consuming honey. His temperature was 34°C, his blood pressure was 70/40 mm Hg, and his heart rate was 30 beats/min. Patient 2, a 57-year-old man, presented to the emergency department with headache, feeling cold, and faintness beginning 3 h after consuming honey. His temperature was 35°C, his blood pressure was 60/40 mm Hg, and his heart rate was 46 beats/min. Patient 3 was a 79-year-old woman who presented with nausea, vomiting, and headache 2 h after consuming honey. Her temperature was 35°C, her blood pressure was 70/40 mm Hg, and her heart rate was 40 beats/min. All 3 patients were discharged in good condition after appropriate therapy. Why Should an Emergency Physician Be Aware of This?Bradycardia and hypotension are frequently encountered in mad honey intoxication. However, intoxication accompanied by hypothermia has attracted little attention to date.

Cardiac Effects of Mad Honey Poisoning and Its Management in Emergency Department: A Review from Turkey.

Mad honey poisoning occurs when honey containing grayanotoxin is digested. The most common clinical signs and symptoms of poisoning involve findings of digestive system irritation, severe bradycardia and hypotension and central nervous system reaction. In this review, we aimed to underline the cardiac effects of mad honey poisoning. We also aimed to raise the awareness of physicians about early diagnosis and treatment of this rare entity.

Mad-Honey Intoxication in Three Individual Patients Admitted to the Emergency Department

Mad-Honey Intoxication in Three Individual Patients Admitted to the Emergency Department

Atrioventriküler Tam Blok ve Akselere Nodal Ritmin Nadir Bir Nedeni; Deli Bal Zehirlenmesi

An unusual type of food poisoning, mad honey intoxication, can be observed in the Black Sea region of Turkey and various other parts of the world. It can occur after ingestion of grayanotoxin-contaminated honey produced from the nectar of Rhododendron ponticum and other plant species, chiefly of the Ericaceae and Sapindaceae families. Mad honey intoxication can result in severe cardiac complications, such as complete atrioventricular block. The diagnosis is generally reached on the basis of the patient's history of honey intake. In this report, we describe the case of a patient who had mad honey related complete atrioventricular block and accelerate nodal rhythm.

Clinical and laboratory findings in mad honey poisoning: a single center experience.

This study is aimed at analyzing the demographic and clinical characteristics, as well as the hematological-biochemical parameters of patients who admitted to the hospital with the diagnosis of mad honey poisoning. A total of 16 patients who were admitted with mad honey intoxication symptoms and treated in Emergency Department of Sakarya Education and Research Hospital between January 2009 and December 2012 were included in the study. Demographic and clinical characteristics of the patients and hematological, biochemical parameters were obtained from hospital records. Heart rate, systolic and diastolic blood pressure on admission and at discharge were obtained retrospectively. Sixteen patients (10 males and 6 females, mean age 58.5 ± 10 years, range between 41 and 79) were included in our study. Heart rate was 42 ± 6 beats/min, systolic blood pressure was 73 ± 19 mmHg, and diastolic blood pressure was 45 ± 17 mmHg on admission. In the evaluation of the patients' heart rhythms on admission to the emergency room, nine (56.3%) patients had sinus bradycardia, three (18.8%) patients had nodal rhythm, two (12.5%) patients had first degree atrioventricular block, and two (12.5%) patients had atrial fibrillation. Atropine 1.1 ± 0.4 mg and saline 1125 ± 465 ml were used to treat patients. Patients were discharged with a stable condition after an average 27.7 ± 7.2 h of follow-up. Heart rate was 75 ± 8 beats/min, systolic blood pressure was 132 ± 7 mmHg, and diastolic blood pressure was 82 ± 6 mmHg at discharge. Mortality was not observed. Hematological and biochemical parameters measured at the time of admission were within normal ranges. Mad honey poisoning should be considered in previously healthy patients with unexplained symptoms of bradycardia, hypotension, and cardiac dysrhythmias. Therefore, diet history should carefully be obtained from the patients admitted with bradycardia and hypotension, and mad honey intoxication should also be considered in the differential diagnosis, as well as primary cardiac, neurologic, and metabolic disorders. Mad honey poisoning may be presented with life-threatening symptoms without any hematological and biochemical disorder.