Abstract
The aims of this study were to evaluate the clinical characteristics and outcomes of patients with grayanotoxin poisoning due to mad honey brought from Nepal. Medical records of patients with mad honey poisoning admitted to the emergency department between 1 January 2004 and 31 May 2012 were retrospectively reviewed. A total of 15 patients were included in this study. In all patients, mad honey was brought from the Himalayan region of Nepal. The mean age was 52.2 years, and 66.7 % were men. The mean amount of mad honey ingested was 47 cc, and the mean time from ingestion to onset of symptoms was 36 min. In all patients, initial vital signs showed hypotension and bradycardia. The initial electrocardiogram showed sinus bradycardia in eight patients, junctional bradycardia in four patients, complete atrioventricular block in two patients, and atrial fibrillation with slow ventricular response in one patient. Four patients were treated with intravenous normal saline solution only. Eleven patients were treated with intravenous normal saline solution and intravenous atropine sulfate in a dose ranging from 0.5 to 2.0 mg. In all patients, the blood pressure and pulse rate returned to normal limits within 24 h. There were no deaths. The clinical characteristics and outcome of grayanotoxin poisonings caused by the ingestion of mad honey from Nepal are similar with those of mad honey from the Black Sea region of Turkey.
References
Sutlupinar N, Mat A, Satganoglu Y (1993) Poisoning by toxic honey in Turkey. Arch Toxicol 67(2):148–150
Onat FY, Yegen BC, Lawrence R, Oktay A, Oktay S (1991) Mad honey poisoning in man and rat. Rev Environ Health 9(1):3–9
Maejima H, Kinoshita E, Seyama I, Yamaoka K (2003) Distinct sites regulating grayanotoxin binding and unbinding to D4S6 of Na(v)1.4 sodium channel as revealed by improved estimation of toxin sensitivity. J Biol Chem 278(11):9464–9471. doi:10.1074/jbc.M212133200
Sayin MR, Karabag T, Dogan SM, Akpinar I, Aydin M (2012) Transient ST segment elevation and left bundle branch block caused by mad-honey poisoning. Wien Klin Wochenschr 124(7–8):278–281. doi:10.1007/s00508-012-0152-y
Osken A, Yaylaci S, Aydin E, Kocayigit I, Cakar MA, Tamer A, Gunduz H (2012) Slow ventricular response atrial fibrillation related to mad honey poisoning. J Cardiovasc Dis Res 3(3):245–247. doi:10.4103/0975-3583.98904
Oguzturk H, Ciftci O, Turtay MG, Yumrutepe S (2012) Complete atrioventricular block caused by mad honey intoxication. Eur Rev Med Pharmacol Sci 16(12):1748–1750
Kalkan A, Gokce M, Memetoglu ME (2012) An unusual clinical state: atrial fibrillation due to mad-honey intoxication. Anadolu kardiyol Derg. doi:10.5152/akd.2012.105
Gunduz A, Kalkan A, Turedi S, Durmus I, Turkmen S, Ayaz FA, Ayar A (2012) Pseudocholinesterase levels are not decreased in grayanotoxin (mad honey) poisoning in most patients. J Emerg Med. doi:10.1016/j.jemermed.2011.08.022
Bayram NA, Keles T, Durmaz T, Dogan S, Bozkurt E (2012) A rare cause of atrial fibrillation: mad honey intoxication. J Emerg Med 43(6):e389–e391. doi:10.1016/j.jemermed.2011.02.021
Alp A, Sappak S, Sezer SD, Colak C, Ozbakkaloglu M (2012) A rare cause of syncope among geriatric patients: mad honey intoxication. Turk J Geriatr 15(1):115–117
Yarlioglues M, Akpek M, Ardic I, Elcik D, Sahin O, Kaya MG (2011) Mad-honey sexual activity and acute inferior myocardial infarctions in a married couple. Tex Heart Inst J 38(5):577–580
Sumerkan MC, Agirbasli M, Altundag E, Bulur S (2011) Mad-honey intoxication confirmed by pollen analysis. Clin Toxicol (Phila). doi:10.3109/15563650.2011.610801
Sayin MR, Dogan SM, Aydin M, Karabag T (2011) Extreme QT Interval Prolongation Caused by Mad Honey Consumption. Can J Cardiol. S0828-282X(11)00363-1
Saritas A, Kandis H, Baltaci D, Erdem I (2011) Paroxysmal atrial fibrillation and intermittent left bundle branch block: an unusual electrocardiographic presentation of mad honey poisoning. Clinics (Sao Paulo) 66(9):1651–1653
Cakar MA, Can Y, Vatan MB, Demirtas S, Gunduz H, Akdemir R (2011) Atrial fibrillation induced by mad honey intoxication in a patient with Wolf-Parkinson-White syndrome. Clin Toxicol (Phila) 49(5):438–439. doi:10.3109/15563650.2011.586351
Yorgun H, Ulgen A, Aytemir K (2010) A rare cause of junctional rhythm causing syncope; mad honey intoxication. J Emerg Med 39(5):656–658 S0736-4679(09)00017-1
Okuyan E, Uslu A, Ozan Levent M (2010) Cardiac effects of “mad honey”: a case series. Clin Toxicol (Phila) 48(6):528–532. doi:10.3109/15563650.2010.497150
Bostan M, Bostan H, Kaya AO, Bilir O, Satiroglu O, Kazdal H, Karadag Z, Bozkurt E (2010) Clinical events in mad honey poisoning: a single centre experience. Bull Environ Contam Toxicol 84(1):19–22. doi:10.1007/s00128-009-9906-2
Gunduz A, Merice ES, Baydin A, Topbas M, Uzun H, Turedi S, Kalkan A (2009) Does mad honey poisoning require hospital admission? Am J Emerg Med 27(4):424–427 S0735-6757(08)00231-3
Demircan A, Keles A, Bildik F, Aygencel G, Dogan NO, Gomez HF (2009) Mad honey sex: therapeutic misadventures from an ancient biological weapon. Ann Emerg Med 54(6):824–829 S0196-0644(09)00641-6
Cagli KE, Tufekcioglu O, Sen N, Aras D, Topaloglu S, Basar N, Pehlivan S (2009) Atrioventricular block induced by mad-honey intoxication: confirmation of diagnosis by pollen analysis. Tex Heart Inst J 36(4):342–344
Aliyev F, Turkoglu C, Celiker C, Firatli I, Alici G, Uzunhasan I (2009) Chronic mad honey intoxication syndrome: a new form of an old disease? Europace 11(7):954–956. doi:eup126
Aliyev F, Turkoglu C, Celiker C (2009) Nodal rhythm and ventricular parasystole: an unusual electrocardiographic presentation of mad honey poisoning. Clin Cardiol 32(11):E52–E54. doi:10.1002/clc.20438
Yildirim N, Aydin M, Cam F, Celik O (2008) Clinical presentation of non-ST-segment elevation myocardial infarction in the course of intoxication with mad honey. Am J Emerg Med 26 (1):108, e101–102. S0735-6757(07)00007-1
Akinci S, Arslan U, Karakurt K, Cengel A (2008) An unusual presentation of mad honey poisoning: acute myocardial infarction. Int J Cardiol 129(2):e56–e58 S0167-5273(07)01458-1
Gunduz A, Durmus I, Turedi S, Nuhoglu I, Ozturk S (2007) Mad honey poisoning-related asystole. Emerg Med J 24(8):592–593 24/8/592
Dursunoglu D, Gur S, Semiz E (2007) A case with complete atrioventricular block related to mad honey intoxication. Ann Emerg Med 50(4):484–485 S0196-0644(07)00679-8
Yilmaz O, Eser M, Sahiner A, Altintop L, Yesildag O (2006) Hypotension, bradycardia and syncope caused by honey poisoning. Resuscitation 68(3):405–408 S0300-9572(05)00305-9
Gunduz A, Turedi S, Uzun H, Topbas M (2006) Mad honey poisoning. Am J Emerg Med 24(5):595–598 S0735-6757(06)00039-8
Ergun K, Tufekcioglu O, Aras D, Korkmaz S, Pehlivan S (2005) A rare cause of atrioventricular block: mad Honey intoxication. Int J Cardiol 99(2):347–348 S0167527304001597
Weiss TW, Smetana P, Nurnberg M, Huber K (2010) The honey man–second degree heart block after honey intoxication. Int J Cardiol 142(1):e6–e7 S0167-5273(08)01340-5
Lennerz C, Jilek C, Semmler V, Deisenhofer I, Kolb C (2012) Sinus arrest from mad honey disease. Ann Intern Med 157(10):755–756. doi:10.7326/0003-4819-157-10-201211200-00021
Shrestha P, Vaidya R, Sherpa K (2009) Mad honey poisoning: a rare case report of seven cases. Nepal Med Coll J 11(3):212–213
Dubey L, Maskey A, Regmi S (2009) Bradycardia and severe hypotension caused by wild honey poisoning. Hellenic J Cardiol 50(5):426–428
Choo YK, Kang HY, Lim SH (2008) Cardiac problems in mad-honey intoxication. Circ J 72(7):1210–1211. doi:JST.JSTAGE/circj/72.1210
Biberoglu S, Biberoglu K, Komsuoglu B (1988) Mad honey. JAMA 259(13):1943
Ozhan H, Akdemir R, Yazici M, Gunduz H, Duran S, Uyan C (2004) Cardiac emergencies caused by honey ingestion: a single centre experience. Emerg Med J 21(6):742–744. doi:10.1136/emj.2003.009324
Koca I, Koca AF (2007) Poisoning by mad honey: a brief review. Food Chem Toxicol 45(8):1315–1318 S0278-6915(07)00146-9
Yavuz H, Ozel A, Akkus I, Erkul I (1991) Honey poisoning in Turkey. Lancet 337(8744):789–790. doi:0140-6736(91)91405-J
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The authors declare no conflicts of interest. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
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Sohn, C.H., Seo, D.W., Ryoo, S.M. et al. Clinical characteristics and outcomes of patients with grayanotoxin poisoning after the ingestion of mad honey from Nepal. Intern Emerg Med 9, 207–211 (2014). https://doi.org/10.1007/s11739-013-0998-7
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DOI: https://doi.org/10.1007/s11739-013-0998-7