Analysis of Mad Honey (Grayanotoksin) Cases Admitted to Duzce University School of Medicine Emergency Department

Abstract

Background: Mad honey is the type of honey made by bees that are nourished from the plants of Rhododendron (Rh.) family, and it contains grayanotoksin (GTX). The most significant types of Rh family, which contain GTX, are Rh. The purpose of this study was to analyze the cases which came to the emergency room because of GTX intoxication in detail in order to help diagnosis, treatment, follow-up and prognosis in daily emergency medicine practice. A total of 36 patients with the symptoms and diagnosis of intoxication after consuming mad honey, were included in the study. Ten healthy individuals who did not have a history of taking mad honey were included in the control group. The study is designed as a prospective case control study. The average GTX level of the group who ate mad honey (studygroup) was 7.88 ng/ml (min: 0.00/max: 30.47). At control group, GTX level was 0 ng/ml. There was no statistically significant relationship between the symptoms (dizziness, nausea, vomiting, weakness, deterioration, angina) and blood GTX level in the study group. Also statistic value reflects relationship between kidney function tests, troponin and control troponin levels in case group. The patients who have absolute decrease in blood pressure and pulse should be questioned by emergency medicine doctors about consuming mad honey. Further studies are needed to demonstrate the relationship between symptoms and GTX poisoning.

Risks for human health related to the presence of grayanotoxins in certain honey

“…Koca and Koca, 2007;Gunduz et al, 2008;Bostan et al, 2010;Demir et al, 2011;Jansen et al, 2012;Erenler, 2016;Aygun et al, 2018;Ullah et al, 2018). Chest pain, hyperthermia, hypothermia and throat burn have also been reported (Yilmaz et al, 2006;Aygun et al, 2016;Tekinsoy et al, 2017;Ullah et al, 2018).…”

“…In two of these studies the relationship between the poisoning symptoms and the grayanotoxin levels in the blood of the patients were analysed (Tekinsoy et al., 2017 ; Aygun et al., 2018 ). In the study of Tekinsoy et al ( 2017 ), the blood analyses in the group of 36 patients with the diagnosis of ‘mad honey’ intoxication revealed concentrations of grayanotoxins (type not specified) with an average of 7.9 ng/mL (range: 0.00–30 ng/mL). No statistically significant relationship between the observed symptoms (dizziness, nausea, vomiting, weakness, deterioration, angina) and the blood grayanotoxins levels in the study group was seen.…”

“…From smaller studies, the multiple clinical manifestations are reported as summarised in Table 10 (Yavuz et al, 1991;Yilmaz et al, 2006;Okuyan et al, 2010;Uzun et al, 2013;Yaylaci et al, 2014Yaylaci et al, , 2015Bilir et al, 2017;Tekinsoy et al, 2017;Aygun et al, 2018).…”

“…In two of these studies the relationship between the poisoning symptoms and the grayanotoxin levels in the blood of the patients were analysed (Tekinsoy et al, 2017;Aygun et al, 2018). In the study of Tekinsoy et al (2017), the blood analyses in the group of 36 patients with the diagnosis of 'mad honey' intoxication revealed concentrations of grayanotoxins (type not specified) with an average of 7.9 ng/mL (range: 0.00-30 ng/mL).…”

Determination of Grayanotoxins from Rhododendron brachycarpum in Dietary Supplements and Homemade Wine by Liquid Chromatography–Quadrupole Time-of-Flight–Mass Spectrometry and Liquid Chromatography–Tandem Mass Spectrometry

“…However, as indicated above, the consumption of such products can cause intoxication in humans, and the severity of symptoms may vary from mild to life-threatening depending upon the quantity consumed. Indeed, grayanotoxin poisoning remains one of the most frequently encountered causes of food intoxication in Turkey, although cases have also been reported in Austria, Korea, and Nepal. − …”