Type 2 myocardial infarction after ingestion of mad honey in a patient with normal coronary arteries

No abstract available.

Chemical constituents in twigs and leaves of Rhododendron fortunei / 中草药

Objective: To study the chemical constituents in the twigs and leaves of Rhododendron fortunei. Methods: The ethyl acetate fraction of 95% ethanol extract from R. fortunei was separated and purified by silica gel and Sephadex LH-20 column chromatography. The structures of the compounds were identified by physicochemical properties and various spectroscopic methods. Results: Twelve compounds were isolated as kaempferol 3-O-α-L-rhamnopyranoside (1), quercitrin (2), myricetin-3-O-α-Lrhamnoside (3), trans-caffeic acid (4), cis-caffeic acid (5), (2R, 3S)-6, 8-di-C-methyldihydrokaempferol (6), fraxetol (7), protocatechuic acid (8), quercetin (9), kaempferol (10), myricetin (11), and grayanotoxin I (12). Conclusion: All the compounds are isolated from the twigs and leaves of R. fortunei for the first time. Compounds 1-8 and 10 are isolated from the plants of Rhododendron L. for the first time, and compounds 3-7 are isolated from the plants in Ericaceae for the first time.

Clinical Analysis of Patients with Cardiotoxicity Caused by Himalayan Mad Honey

PURPOSE: The aim of this study was to evaluate the clinical characteristics and outcome of patients who presented to the emergency department (ED) with cardiotoxicity caused by ingestion of Himalayan mad honey. METHODS: Medical records of 12 patients who presented to the ED from January 1, 2005 to December 31, 2012 with cardiotoxicity caused by ingestion of Himalayan mad honey were retrospectively reviewed. RESULTS: The mean age of patients was 54.5 years and 58.3% were men. The median amount of mad honey ingested was 30.0 cc, and the mean time from ingestion to onset of symptoms was 39.4 minutes. All patients had hypotension and bradycardia upon arrival in the ED. The initial electrocardiogram showed sinus bradycardia in seven patients, junctional bradycardia in four patients, and atrial fibrillation with slow ventricular response in one patient. Four patients were treated with intravenous normal saline solution only. Eight patients were treated with intravenous normal saline solution and atropine sulfate in a dose ranging from 0.5 to 2.0 mg. Blood pressure and pulse rate returned to normal limits within 24 hours in all patients. CONCLUSION: Our study showed that all patients with cardiotoxicity caused by ingestion of Himalayan mad honey had severe hypotension, bradycardia, and bradyarrythmias, including sinus bradycardia and junctional bradycardia and all patients responded well to conservative treatment, including intravenous normal saline solution and intravenous atropine sulfate.

Grayanotoxin Poisoning from Honey: A Case Report

Honey is produced by bees from nectar collected from nearby flowers. Sometimes, honey produced from the Rhododendron species is contaminated by Grayanotoxin (GTX) in Nepal and other countries. There have been reports of GTX intoxication, also known as 'mad honey disease', from honey produced in countries other than Korea. The importation of wild honey has been prohibited by the Korean Food and Drug Administration since 2005, yet it is still distributed within Korea by the occasional tourist. We report a case of GTX intoxication from contaminated honey which included the symptoms of nausea, vomiting, general weakness, dizziness, blurred vision, hypotension and sinus bradycardia. By means of infusion with normal saline and atropine sulfate, the patient's condition fully recovered within 8 hours of hospital admission, and she was discharged without any complications.

A case of Systemic Toxicity that Occurred in an Adult Who Intentionally Ingested Rhododendron Sclippenbashii

It is well known that Rhododendron sclippenbashii contains the toxic material grayanotoxin. So, Koreans do not eat it, but they do eat azalea although it contains grayanotoxin. That is why there have been no reports about Rhododendron sclippenbashii intoxication after ingesting it intentionally, not accidentally. In this case, the patient was admitted to the emergency room with several toxic symptoms after intentionally consuming 50 blossoms of Rhododendron sclippenbashii to get rid of thirst. Treatment with saline infusion and atropine was successful and the outcome was favorable enough in this case to produce a complete cure without any sequelae at discharge. But toxic symptoms were seen for 24 hours, although the symptoms usually fade in 9 hours. Therefore, we should carefully treat and observe, for over 24 hours, the patient who intentionally ingests about 50 blossoms of Rhododendron sclippenbashii.

A Case of Grayanotoxin Intoxication Presenting with Mental Changes and Vomiting / 대한소아소화기영양학회지

Rhododendron species is one of the largest and most diverse genera in the plant kingdom, comprising over 800 species and existing all over the globe. Grayanotoxin intoxication is caused by ingestion of honey and flowers. Grayanotoxin exists in honey, flowers, pollen, and nectar of the Rhododendron species. Grayanotoxin-intoxicated patients may present with nausea, vomiting, dizziness, weakness, hypotension, bradycardia, and syncope for several hours. We report a case of grayanotoxin intoxication associated with mental changes. A 9-year-old male presented with impaired consciousness and delirium 26 hours after eating about 10 rhododendron sclippenbachii flowers. A brain MRI and EEG were normal. Parenteral fluids were administered and these symptoms resolved completely in 17 hours.

A Case of Grayanotoxin Intoxication Presenting with Mental Changes and Vomiting / 대한소아소화기영양학회지

Rhododendron species is one of the largest and most diverse genera in the plant kingdom, comprising over 800 species and existing all over the globe. Grayanotoxin intoxication is caused by ingestion of honey and flowers. Grayanotoxin exists in honey, flowers, pollen, and nectar of the Rhododendron species. Grayanotoxin-intoxicated patients may present with nausea, vomiting, dizziness, weakness, hypotension, bradycardia, and syncope for several hours. We report a case of grayanotoxin intoxication associated with mental changes. A 9-year-old male presented with impaired consciousness and delirium 26 hours after eating about 10 rhododendron sclippenbachii flowers. A brain MRI and EEG were normal. Parenteral fluids were administered and these symptoms resolved completely in 17 hours.

Three Cases of Mad-honey Poisoning Presenting with Cardiovascular Emergencies

Mad-honey poisoning results from the ingestion of grayanotoxin-contaminated honey, which is extracted by bees from the leaves and the flowers Rhododendron species. The grayanotoxins bind to sodium channels in cell membranes and prevent inactivation; thus, excitable cells are maintained in a state of depolarization. Cardiac disturbances are the main signs in this poisoning. Bradycardia, and arterial hypotension have the potential to cause death in untreated cases but no fatalities have been reported in the literature. Here, we report three cases of mad-honey poisoning. All of the patients showed bradycardia, hypotension, and syncope. The hypotension responded to the administration of fluids, and the bradycardia responded to atropine treatment. All three patients recovered fully within 24 hours. Mad-honey poisoning should be kept in mind for any patients admitted with unexplained hypotension, bradycardia, and other rhythm disturbances, and patients who have eaten honey must be examined carefully.

A Case of Severe Bradyarrhythmia after Ingestion of Rhododendron Brachycarpum

Rhododendron brachycarpum has been known as a panacea in Korean folk medicine, and is used to treat various diseases including hypertension. Excessive ingestion can cause intoxication by grayanotoxin. We experienced a 59 year-old man suffering of grayanotoxin intoxication following excessive ingestion of Rhododendron brachycarpum. The patient presented dizziness, weakness, and chest discomfort with cold sweats. Electrocardiography showed marked sinus bradycardia with atrio-ventricular dissociation. With intravenous saline and atropine, the patient recovered. This case calls attention to the potential cardiotoxicity of Korean folk medicine Rhododendron brachycarpum.