Mad honey poisoning
Abdulkadir Gunduz MD, Suleyman Turedi MD, Hukum Uzun MD, and Murat Topbas MD

The American Journal of Emergency Medicine
Volume 24, Issue 5 , September 2006, Pages 595-598

Abstract (and full-text) online at the ScienceDirect website. Full-text will
cost money unless you have a subscripton or library proxy.

Abstract

Grayanotoxin intoxication, which is mostly seen in the eastern Black Sea region
of Turkey, stems from the 'mad honey' made by bees from the rhododendron
plant flowers. In low doses, this causes dizziness, hypotension, and
bradycardia, and in high doses, impaired consciousness, seizures, and
atrioventricular block (AVB).

This case study was designed as a series of cases of patients (6 women, 2 men)
aged between 35 and 75 years. All of the patients' physical examinations
revealed hypotension; 4 patients had sinus bradycardia, 3 had nodal rhythm, and
1 had complete AVB. In all patients, except for the patient with AVB, heart
rate and blood pressure returned to normal limits within 2 to 6 hours. Two
patients were monitored in the coronary intensive care unit. Of these 2, 1 was
discharged on the second day. The other was fitted with a temporary pacemaker
and was discharged on the third day. All the other patients were kept in for a
6-hour observation period and were then discharged from the ED.

To date, 58 such cases have been reported, but we saw 8 patients within 2005.
It is commonly seen in the east of the Black Sea region, although cases may
occur from all over the eastern Black Sea region of Turkey. So far, no cases of
death have been reported, although grayanotoxin causes adverse effects on the
cardiovascular and respiratory systems and is therefore of considerable
importance. 


PS besides rhododendrons, honey from the common oleander (Nerium Oleander) and
almond blooms may be toxic as well. Additionally, readers are reminded that the
common azalea is in the rhododendron family.

Tom Billings