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Grayanotoxin is a naturally occurring sodium channel toxin which enters the human food supply by honey made from the pollen and nectar of the plant family Ericaceae in which rhododendron is a genus. Grayanotoxin/mad honey poisoning is a little known, but well studied, cholinergic toxidrome resulting in incapacitating and, sometimes, life-threatening bradycardia, hypotension, and altered mental status. Complete heart blocks occur in a significant fraction of patients. Asystole has been reported. Treatment with saline infusion and atropine alone is almost always successful. A pooled analysis of the dysrhythmias occurring in 69 patients from 11 different studies and reports is presented. The pathophysiology, signs, symptoms, clinical course, and treatment of grayanotoxin/mad honey poisoning are discussed. In the nineteenth century grayanotoxin/mad honey poisoning was reported in Europe and North America. Currently, documented poisoning from locally produced honey in Europe or North America would be reportable. Possible reasons for this epidemiologic change are discussed.

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Carob pod is the fruit of the carob tree (Ceratonia siliqua L. Fabaceae). The fruit and its products, sold both in large stores and local markets, contribute strongly to the diet of people living in the Mediterranean areas of Europe and Turkey. This study reports the composition of carob pods sampled in West and South Anatolia. Sucrose (437.3 mg/g dry weight), glucose (395.8 mg/g dry weight) and fructose (42.3 mg/g dry weight) were the major sugars identified and quantified in the fruit. Total phenolics (13.51 mg gallic acid equivalents [GAE]/g dry weight), proanthocyanidin (0.36 mg GAE/g dry weight), gallotannins (0.41 catechin equivalents [CE]/g dry weight) and flavanols (3.21 mg CE/g dry weight protein) content of the fruit were also determined. Gallic acid (3.27 mg/g dry weight) was the most abundant phenolic acid present in all three phenolic fractions (free, ester and glycoside) isolated from pods. Aspartic acid (18.25 mg/g dry weight protein) was the predominant amino acid in the pod protein fraction. Eight minerals were quantified in the fruit. Among the analyzed major minerals, K (9.70 mg/g dry weight) was the most abundant element present, and the pods were richer in Ca than in P and Mg. Levels of trace minerals were comparable to other plant species. The data are discussed in terms of the nutritional value of the carob pod. PRACTICAL APPLICATION The use of carob fruit and its food products in Turkey has been increasing in recent years. However, knowledge about the composition of carob fruit pod produced in Turkey as well as in Mediterranean countries is lacking. The present work describes a composition scale and the advantages to food technologists and consumers who use the fruit and its fruit products in their diets. The results of the study can also aid in the assessment of adequate compositional information for further studies.