Examination using LC-MS/MS determination of grayanotoxin levels in blood, urine, and honey consumed by patients presenting to the emergency department with mad honey intoxication and relations with clinical data: a preliminary study

Abstract

BACKGROUND AND OBJECTIVEIntoxications related to ”mad honey” are frequently encountered in the Black Sea region of Turkey. Intoxication is established on the basis of whether honey was consumed when history was taken at presentation. The search for a simple and reliable method for showing the grayanotoxins (GTXs) in mad honey in body fluids and in honey consumed by patients is still at the research stage. The purpose of this preliminary study was to investigate GTX levels in blood, urine, and honey consumed by patients with mad honey intoxication and to determine whether there is an association with clinical status.DESIGN AND SETTINGSThis descrptive study was conducted at the department of Emergency Medicine of Karadeniz Technical University Medical Faculty in Turkey. Mad honey, blood, and urine samples were obtained from patients between September 2013 and October 2014.METHODSFour cases presenting the Department of Emergency Medicine and diagnosed with mad honey intoxication were included in the study. GTX levels in blood, urine, and honey consumed by patients were determined using liquid chromatography–tandem mass spectrometry.RESULTSPatients’ mean blood GTX I level was 30.62 ng/mL, GTX III level 4.917 ng/mL, urine GTX I level 0.447 mg/mL, and GTX III level 1.998 mg/mL. The mean GTX I level in the honey samples consumed was 4.683 mg/g and GTX III level 8.423 mg/g.CONCLUSIONThe present study is unique in representing the first time that GTXs have been determined in human body fluids. There is now an urgent need for a large series of studies to provide statistical evidence whether there is a relationship between levels of toxins in human body fluids and clinical picture.

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

“…Similar to our study, the relationship between GTX level and symptoms was investigated in the study conducted by Aygun et al [22]. Although there was no correlation between the amount of honey and the level of GTX and symptoms, the findings were the fastest in this patient and the GTX was the highest in this patient.…”

“…In one study, normal sinus rhythm and normal blood pressure values were obtained after an average of 0.78 mg of atropine and 841 ± 332 mL of 0.9% isotonic fluid. In the same study, there were no patients who need intensive care and the temporary cardiac pacemaker application [22]. In our study, normal sinus rhythm and normal blood pressure values were obtained in patients with atropine and isotonic fluid treatment.…”

“…In our study, the symp- found to use it for gastrointestinal complaints, 11 patients for hypertension, one patient for diabetes and one patient for cancer prevention. It was also determined that there was no use in any patient as a sexual performance enhancer [22]. In our study, 33 patients from 36 patients who had mad honey stated that they took it for healing purposes, because they were good for them as an alternative medicine and the other 3 patients only ate mad honey as they love it just for nutritional consumption.…”

“…In cases of GTX poisoning, although symptoms are serious and dangerous, most cardiac monitoring, fluid therapy, and intravenous atropine therapy are sufficient to restore symptoms [22] [28]. In one study, normal sinus rhythm and normal blood pressure values were obtained after an average of 0.78 mg of atropine and 841 ± 332 mL of 0.9% isotonic fluid.…”

Mad honey: uses, intoxicating/poisoning effects, diagnosis, and treatment

“…Other possible techniques for the detection of grayanotoxin are HPLC, LCMS/MS, nuclear magnetic resonance, and infrared-based technologies. 64,90,[107][108][109][110]130 For corroborative evidence, pollen grains from Rhododendron (its owers are rich in grayanotoxin) can be investigated occasionally in honey samples. Cardiac ischemia and rhythm abnormalities should be checked by ECG.…”