Yaylacı S, Ayyıldız O, Aydın E, Osken A, Karahalil F, Varım C, Demir M V, Genç A B, Sahinkus S, Can Y, Kocayigit İ, Bilir C
Department of Internal Medicine, Fındıklı State Hospital, Rize, Turkey.
Eur Rev Med Pharmacol Sci. 2015 Dec;19(23):4647-53.
This study aims to investigate the demographic, toxicological characteristics of the mad honey intoxication at ages 65 and above, to analyze the electrocardiographic parameters, and to compare with the mad honey intoxication at ages below 65 years.
Eighty-two patients, who had been treated and followed-up between June 2013 and November 2014 in the Emergency Service of the Findikli State Hospital, Turkey, due to diagnosis of mad honey intoxication, were included in our observational study. Age, gender, toxicological characteristics, laboratory parameters, heart rates, systolic and diastolic blood pressures, laboratory analyses and electrocardiographic data of the patients were recorded and analyzed. Patients with known coronary artery disease, chronic renal failure, arrhythmias, valvular heart disease, history of thyroid disease and electrolyte imbalance were not included in the study.
Eighty-two (80.5% was male and the mean age was 53 ± 15 years) patients followed-up due to mad honey intoxication were included in our study. There were 64 (78%) patients aged below 65 years, and 18 (22%) patients aged 65 and above. The mean heart rate was 45 ± 7 beats/min, systolic blood pressure was 83 ± 12 mmHg and diastolic blood pressure was 52 ± 9 mmHg on admission. The onset of symptoms of the patients was found as 0.84 hours on average after mad honey consumption, the average amount of honey consumed was 3.7 ± 1.1 tablespoons, and the mean recovery time of the symptoms was found to be 1.04 hours. The most common presenting symptoms were nausea-vomiting in 82 (100%) patients and dizziness in 73 (89%) patients. Patients were found to consume mad honey mostly for achieving a remission in gastrointestinal complaints (n=18, 22%), and for utilizing its blood pressure lowering properties (n=11, 13.4%), in addition to the dietary consumption. Looking at the heart rates of the patients on admission to the emergency service, 65 (79.3%) patients had normal sinus rhythm/sinus bradycardia, 12 (14.6%) patients had a 1st degree atrioventricular block, 3 (3.7%) patients had nodal rhythm, 1 (1.2%) patient had atrial fibrillation and 1 (1.2%) patient had preexcitation. There were no significant pathological findings in the routine laboratory examinations of patients. It was found that all patients achieved normal sinus rhythm and normal blood pressure values after medical treatment, and were discharged approximately 5.65 hours after observation and follow-up. In our study, prolonged intensive-care need, pacemaker need and mortality caused by mad honey intoxication were not found. In the comparison of data of all patients above and below 65 years of age, there was a statistically significant finding that the geriatric patients consume mad honey mostly for hypotensive purposes and gastrointestinal complaints; in addition, the symptoms were starting early and the recovery period was longer in geriatric patients.
The mad honey poisoning should be considered in previously healthy patients with unexplained symptoms of bradycardia, hypotension, and atrioventricular block. Therefore, diet history should carefully be obtained from the patients admitted with bradycardia and hypotension. And, in addition to the primary cardiac, neurological and metabolic disorders, mad honey intoxication should also be considered in the differential diagnosis. In geriatric patients admitted due to mad honey intoxication, the mad honey is usually consumed to reduce blood pressure and resolve gastrointestinal problems; and, their symptoms begin early, and last longer after mad honey consumption. In terms of other parameters, the geriatric age group has similar characteristics to non-geriatric age group.
本研究旨在调查65岁及以上人群食用疯蜜中毒的人口统计学和毒理学特征，分析心电图参数，并与65岁以下人群的疯蜜中毒情况进行比较。
纳入82例因疯蜜中毒于2013年6月至2014年11月在土耳其芬迪克利州立医院急诊科接受治疗和随访的患者，进行观察性研究。记录并分析患者的年龄、性别、毒理学特征、实验室参数、心率、收缩压和舒张压、实验室分析及心电图数据。已知患有冠状动脉疾病、慢性肾衰竭、心律失常、心脏瓣膜病、甲状腺疾病史及电解质失衡的患者不纳入本研究。
本研究纳入82例因疯蜜中毒接受随访的患者（男性占80.5%，平均年龄53±15岁）。其中65岁以下患者64例（78%），65岁及以上患者18例（22%）。入院时平均心率45±7次/分钟，收缩压83±12mmHg，舒张压52±9mmHg。患者食用疯蜜后症状平均发作时间为0.84小时，平均食用量为3.7±1.1汤匙，症状平均恢复时间为1.04小时。最常见的症状为恶心呕吐（82例，100%）和头晕（73例，89%）。发现患者食用疯蜜主要是为缓解胃肠道不适（18例，22%）、利用其降压特性（11例，13.4%），此外还有饮食消费。观察急诊科入院患者的心率，65例（79.3%）患者为正常窦性心律/窦性心动过缓，12例（14.6%）患者为一度房室传导阻滞，3例（3.7%）患者为结性心律，1例（1.2%）患者为心房颤动，1例（1.2%）患者为预激综合征。患者常规实验室检查无明显病理发现。发现所有患者经治疗后均恢复正常窦性心律和正常血压值，观察和随访约5.65小时后出院。本研究未发现因疯蜜中毒导致的长期重症监护需求、起搏器需求及死亡情况。在比较所有65岁及以上和65岁以下患者的数据时，有一项具有统计学意义的发现，即老年患者食用疯蜜主要是为了降压和缓解胃肠道不适；此外，老年患者症状出现早且恢复期更长。
对于既往健康但出现不明原因心动过缓、低血压和房室传导阻滞症状的患者，应考虑疯蜜中毒。因此，对于因心动过缓和低血压入院的患者，应仔细询问饮食史。此外，在鉴别诊断中，除了原发性心脏、神经和代谢紊乱外，还应考虑疯蜜中毒。因疯蜜中毒入院的老年患者，食用疯蜜通常是为了降压和解决胃肠道问题；而且，他们的症状出现早，食用疯蜜后持续时间更长。在其他参数方面，老年人群与非老年人群具有相似特征。
