The hidden dangers of high-altitude honey: a case report of grayanotoxin poisoning causing hypotension and bradycardia with clinical management
Aashish Thapa, Achala Adhikari, Prasamsa Pande, Sujan Niroula, Abhishek Pandey, Archana PandeyIntroduction and importance:
Grayanotoxin is found in honey harvested from high-altitude areas where Rhododendron species grow. Grayanotoxin poisoning (GP), also called mad honey poisoning, can occur when honey containing grayanotoxin is ingested. This toxin persistently activates sodium channels and depolarizes cells, which can produce prolonged vagal stimulation, causing hypotension and sinus bradycardia.
Case presentation:
We present the case of a 36-year-old male with GP. The case presented with abdominal discomfort and multiple episodes of vomiting after consuming honey. On arrival at the emergency department, he was found to have bradycardia and hypotension.
Clinical discussion:
Patients with GP may present with sinus bradycardia, hypotension, and neurological symptoms, along with nausea, vomiting, vertigo, and headaches. Serious manifestations such as cardiac arrhythmias, seizures, loss of consciousness, and, rarely, atrioventricular block, myocardial infarction, asystole, and hepatotoxicity have also been reported. Lower doses of mad honey may cause milder symptoms, while higher doses may require medical intervention. In this case, the patient was managed with intravenous ondansetron, fluids, and atropine. The patient was discharged after an overnight stay in the hospital, with no complications noted during follow-up.
Conclusion:
Mad honey poisoning should be suspected in patients who present with clinical manifestations such as bradycardia and hypotension, along with a history of ingesting honey from high-altitude areas where rhododendrons are prevalent.