Mad honey intoxication: A case report from eastern Nepal

Mad honey poisoning, caused by ingestion of honey contaminated with grayanotoxins from specific rhododendron species, poses health risks in regions like Nepal, Turkey, Canada, and Japan. Grayanotoxins bind to sodium channels, leading to prolonged depolarisation and causing bradycardia and hypotension. Historically used in traditional medicine, mad honey’s recent recreational consumption has increased, leading to cases of intoxication from excessive use. We report a case of mad honey poisoning in a 53-year-old woman who consumed approximately 30 mL of honey bought from eastern Nepal, presenting with drowsiness, bradycardia, and hypotension. Despite initial stabilization with atropine, hydrocortisone, and fluid resuscitation, her condition required prolonged monitoring for 72 h. This case highlights the need to consider mad honey poisoning in patients presenting with altered sensorium or unexplained hypotension, even outside endemic regions. Efforts to raise public awareness, regulate honey sales, and improve diagnostic capabilities are essential to prevent and manage future cases. Further studies on toxin variability and rhododendron species in Nepal are also needed. • Rare case of mad honey poisoning reported from eastern Nepal. • Bradycardia and hypotension followed ingestion of 30 mL of contaminated honey. • Managed with atropine, hydrocortisone, and prolonged monitoring for 72 h. • Public health awareness and regulation critical to prevent future intoxications. • Further research needed on toxin variability and rhododendron species in Nepal.