Three Cases of Mad-honey Poisoning Presenting with Cardiovascular Emergencies

ABSTRACT

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.