Journal of The Korean Society of Clinical Toxicology

Clinical Analysis of Patients with Cardiotoxicity Caused by Himalayan Mad Honey: Sung Ho Kim, Dong Woo Seo, Seung Mok Ryoo, Won Young Kim, Bum Jin Oh, Kyoung Soo Lim, Chang Hwan Sohn; J Korean Soc Clin Toxicol. 2013;11(2):119-126. Published online December 31, 2013

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Abstract PDF: 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: Gi-Hun Choi, Ki-Cheol You, Soon-Joo Wang, Tae-Jin Park; J Korean Soc Clin Toxicol. 2012;10(1):37-40. Published online June 30, 2012

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Abstract PDF: 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 Report of Saliva-type Hyperamylasemia in Mad Honey Poisoning: Kun-Woo Lee, Kyu-Nam Park, Mi-Jin Lee; J Korean Soc Clin Toxicol. 2006;4(2):166-169. Published online December 31, 2006

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Abstract PDF: Poisonings caused by 'mad honey' are known to occur in response to grayanotoxins, which bind to sodium channels in the cell membrane, increasing membrane sodium permeability and preventing inactivation. Mild symptoms of mad honey intoxication are dizziness, weakness, hypersalivation, nausea, vomiting, and paresthesia. Severe intoxication, however, leads to serious cardiac manifestations such as atrioventricular block, dose-dependent hypotension, bradycardia, and respiratory depression. Atropine and vasoactive drugs improve symptoms of both bradycardia and respiratory rate depression. We report an unusual case of saliva-type hyperamylasemia in a mad honey poisoning patient who developed clinically significant bradycardia. She recovered fully within 3 days following atropine administration and medical treatment.

Two Cases of Mad-Honey Poisoning with Cardiovascular Symptom: Young-Gil Ko, Kyung-Hwan Kim, Ah-Jin Kim, Dong-Wun Shin, Jun-Soek Park, Jun-Young Roh, Ji-Young Ahn; J Korean Soc Clin Toxicol. 2006;4(1):78-81. Published online June 30, 2006

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Abstract PDF: Mad-honey poisoning is mainly brought about by the honey imported from Napal, Turkey, Brazil and other parts of Europe. This mad honey is extracted from Ericaceae plants of Rhododendron species and contains grayanotoxins that causes poisoning. These toxic compounds exert a specific stimulatory action on membrane permeability to Na+ions in various excitable tissues and cause depolarization of cell membranes. The toxic effects of grayanotoxins contained honey are mainly cardiovascular disturbances with bradycardia, cardiac arrhythmia, hypotension. There are Other symptoms like nausea, vomiting, salivation, dizziness, weakness and loss of consciousness. The precise amount for a toxic dose is not known. In general the severity of the honey poisoning depends on the amount ingested. Two cases of mad-honey poisoning are described here. Both patients showed bradycardia and arterial hypotension after ingestion of honey which was brought from Nepal. They were recovered fully within 24 hours after administration of fluids and atropine sulphate.

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