Thapa Anil Jung, Chapagain Subodh, Lamichhane Samit, Aryal Egesh, Sapkota Aashish, Ghimire Abishkar, Bhatt Bikash, Agarwal Sweta, Khadka Aayushma, Parajuli Suraj
Nepal Army Institute of Health Sciences.
Manosamajik Apanga Bandi Hospital, Lalitpur.
Ann Med Surg (Lond). 2024 Aug 14;86(9):4975-4978. doi: 10.1097/MS9.0000000000002448. eCollection 2024 Sep.
Mad honey is commonly used for hypertension, and coronary artery disease, and as a sexual stimulant. Patients with mad honey poisoning present with dizziness, nausea, syncope, blurred vision, bradycardia, and hypotension with ECG findings of sinus bradycardia, complete AV block, and ST elevation.
Here, the authors report five cases admitted to our tertiary care center following the consumption of mad honey. The amount of ingestion of honey varies from 1 to 2 teaspoons (~10-20 ml). Most of the cases presented with chief complaints of nausea, dizziness, and vomiting, and all the cases had hypotension and bradycardia. Two cases were admitted to the ward and three of them were admitted to the ICU for further management. They were managed with intravenous fluid, injection atropine along with adjunctive vasopressor and oxygen whenever necessary.
Mad honey contains grayanotoxin extracted from the nectar of Rhododendron species. This honey contains grayanotoxin, which binds to sodium channels in its open state causing hyperpolarization of the sodium channel predominantly causing gastrointestinal, neurological, and respiratory symptoms. Intravenous fluids and injection atropine are the mainstays of management in an ICU setup. Some also may require vasopressors.
Mad honey poisoning is rare, and limited cases have been reported in Nepal. Physicians should consider mad honey poisoning in cases with ingestion history and clinical symptoms, as it may be a clinical diagnosis due to limited lab tests for grayanotoxin intoxication. Supportive management still forms the cornerstone for its management after diagnosis.
疯蜜常用于治疗高血压和冠状动脉疾病，还用作性兴奋剂。疯蜜中毒患者会出现头晕、恶心、晕厥、视力模糊、心动过缓和低血压，心电图表现为窦性心动过缓、完全性房室传导阻滞和ST段抬高。
在此，作者报告了5例食用疯蜜后入住我们三级医疗中心的病例。蜂蜜摄入量从1至2茶匙（约10 - 20毫升）不等。大多数病例的主要症状为恶心、头晕和呕吐，所有病例均有低血压和心动过缓。2例入住病房，3例入住重症监护病房接受进一步治疗。必要时，对他们进行静脉输液、注射阿托品，并辅以血管升压药和氧气治疗。
疯蜜含有从杜鹃花属植物花蜜中提取的灰安诺毒素。这种蜂蜜中的灰安诺毒素会与处于开放状态的钠通道结合，导致钠通道超极化，主要引起胃肠道、神经和呼吸系统症状。在重症监护病房，静脉输液和注射阿托品是主要治疗方法。一些患者可能还需要血管升压药。
疯蜜中毒较为罕见，尼泊尔报告的病例有限。医生在有摄入史和临床症状的病例中应考虑疯蜜中毒，因为由于灰安诺毒素中毒的实验室检测有限，这可能是一种临床诊断。诊断后，支持性治疗仍然是其治疗的基石。
