Mad Honey Poisoning: A Review
2017
Mad honey, which is different from normal commercial honey, is contaminated with grayanotoxins and causes
intoxication. It is used as an alternative therapy for hypertension, peptic ulcer disease and is also being used more
commonly for its aphrodisiac effects. Grayanotoxins, found in rhododendron plant, act on sodium ion channels and
place them in partially open state. They also act on muscarinic receptors. Cardiac manifestations of mad honey
poisoning include hypotension and rhythm disorders such as bradycardia, nodal rhythm, atrial fibrillation, complete
atrioventricular block or even complete heart block. Additionally, patients may develop dizziness, nausea and
vomiting, weakness, sweating, blurred vision, diplopia and impaired consciousness. Diagnosis is made with history
of honey intake and clinical presentation. Treatment is symptomatic. Patients presenting with severe hypotension
and bradycardia may need prompt treatment with fluids, atropine or even temporary pacing if other measures fail.
Although fatalities are rare, poisoning may be hard to recognize and arrhythmias may be life-threatening.
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