Cardiac effects of “mad honey”: a case series

Abstract

BACKGROUND: Grayanotoxins (GTX), also known as andromedotoxins, are produced by plants of the Ericacae family. This toxin is responsible for "mad honey" intoxication, which can present with fatal cardiac bradyarrhythmias and circulatory collapse. GTXs lead to cardiac toxicity because they increase sodium channel permeability and activate the vagus nerve. OBJECTIVE: We evaluated 42 patients (33 males) prospectively who had been hospitalized with diagnosis of "mad honey" intoxication in a state hospital setting. METHODS AND RESULTS: The median age of patients was 48.5 years and all patients were admitted with complaints of nausea, vomiting, dizziness, fainting, and sweating. Five of the patients had syncope before admission. On admission, the mean systolic blood pressure was 73.1 ± 12.7 mmHg, the mean diastolic blood pressure was 52.1 ± 11.3 mmHg, mean heart rate was 38 ± 7 bpm. On initial electrocardiograms, 18 patients had sinus bradycardia, 15 patients had complete atrioventricular block, and 9 patients had nodal rhythm. All patients were monitored in a coronary care unit and treated symptomatically with atropine, intravenous fluids, and dopamine. None of the patients needed temporary pacing and all were discharged without complications. CONCLUSION: "Mad honey," which is produced widely in northern parts of Turkey can be toxic. This intoxication should be considered in patients admitted to emergency department with bradycardia and hypotension especially in regions where this honey is produced.