“Mad honey and the heart: a case report of transient bradycardia and hypotension from Nepal”

Consuming honey contaminated with grayanotoxins, which are derived from specific Rhododendron species (known locally as Laliguras) found in Nepal’s hilly and Himalayan regions, can result in mad honey poisoning. There are plants with high concentrations of Grayanotoxin in a number of places across the world, including Brazil, Japan, Nepal, Turkey, and North America. We documented a case of a 59-year-old male exhibiting acute nausea, recurrent vomiting, dizziness, hypotension (BP 60/40 mmHg), and bradycardia (42 bpm) approximately 60–80 min following the consumption of 3–4 teaspoons of locally sourced “mad honey.” There is no history of substance abuse, abnormal movement, dyspnea, or chest pain. He was awake, fully conscious, and had no other problems with his body. The electrocardiogram showed sinus bradycardia with no ischemic changes, and the cardiac enzymes were normal. Other possible causes, such as myocardial infarction, hypovolemia, sepsis, beta-blocker overdose, and organophosphate poisoning, were ruled out. A diagnosis of mad honey (grayanotoxin) poisoning was established due to the typical clinical symptoms and a history of honey consumption. The patient received intravenous fluids and atropine, resulting in quick stabilization of vital signs. He maintained stability throughout 24 hours of observation and was discharged with advice to refrain from consuming wild or unprocessed honey. This situation highlights the importance of recognizing mad honey poisoning as a reversible factor for bradycardia and hypotension. Although rare, mad honey poisoning can rapidly trigger bradycardia, low blood pressure, and digestive discomfort. With early recognition and timely care, including fluids and atropine, patients typically make a full recovery. Clinicians should stay alert to this possibility, particularly in areas where wild honey is traditionally consumed. Awareness is crucial in regions where wild honey is consumed. Mad honey (grayanotoxin) poisoning is a significant and reversible cause of acute bradycardia and hypotension, particularly in areas where wild or unprocessed honey is commonly ingested. A complete dietary history is required for diagnosis, as there is no routine laboratory test for grayanotoxin toxicity, and diagnosis is essentially clinical after ruling out other causes. Grayanotoxins work by binding to voltage-gated sodium channels and raising vagal tone, resulting in sinus bradycardia, hypotension, and gastrointestinal complaints. Supportive treatment with intravenous fluids and atropine is usually adequate to achieve quick stabilisation and complete recovery in most individuals. Early detection of mad honey poisoning can save superfluous examinations and interventions, allowing for timely, targeted care.