A RARE CAUSE OF SEVERE BRADYCARDIA AND HYPOTENSION: MAD HONEY POISINING

Mad-honey intoxication is an unusual entity due to ingestion of mad-honey, made by bees using wild fl owers of the rhododendrons and other plants of the Ericacea family (1). We report on a 45-year-old woman who was admitted with complaints of dizziness and diplopia that began 4 hours after eating a few dessert spoons of mad-honey. She had no previous history of heart disease or drug use. At presentation, she was awake and cooperative. Her blood pressure and heart rate were 70/50 mmHg and 45 beats/min, respectively. Electrocardiogram (ECG) revealed sinus bradycardia initially, followed by negative T waves on the anterior derivations. Cardiac enzymes, blood biochemistry and blood count were normal. Parenteral fl uids were administered, and 1 mg atropine was given. After treatment her pulse was 60/min and blood pressure was 90/55 mmHg. Twelve hours after admission her symptoms and ECG abnormalities had resolved. The patient was discharged after 24 hours of monitorisation. The diagnosis is generally reached on the basis of the patient’s history. The cause is a high concentration of grayanotoxine-I (andromedotoxine, rhodotoxin) which is a naturally occurring sodium channel toxin that induces increased parasympathetic tone. The result may be a life-threatening bradycardia, hypotension, and altered mental status. Symptoms occur after a dose-dependent latent period of a few minutes to 2 hours or more. Dizziness, weakness, hypersalivation, nausea and vomiting can occur and decreased respiratory rate can be observed . With higher doses, impaired consciousness and seizures may be seen with complete atrioventricular block (3). Almost all cases respond to symptomatic treatment with fl uids and atropine sulfate, which improves both bradycardia and respiratory depression (4). Although rare, mad-honey intoxication must be kept in mind as a possible cause of sudden haemodynamic instability in patients consuming honey imported from endemic areas.