An indispensable toxin known for 2500 years: victims of mad honey

Aim: Mad honey (bitter honey) is a local name for a particular type of honey used in alternative medicine to treat gastric pain, bowel disorders, and hypertension, and as a sexual stimulant in the Black Sea coastal region of Turkey. Grayonotoxin behaves like cholinergic agents and has dosage dependent adverse effects on the cardiovascular system including bradycardia, atrioventricular block (AVB), and arterial hypotension. In this manuscript, we report 37 cases of mad honey intoxication from the western Black Sea region. Materials and methods: This was a retrospective case series of 37 patients who were admitted to the emergency department of a tertiary center with a history of mad honey intake between June 2003 and June 2010. Results: Patients consisted of 31 males (83.7%) and 6 females (16.3%). Mean age was 56.17 ± 12.56 and 69.66 ± 11.75 in males and females, respectively. Initial physical examination findings included hypotension in 18 patients, sinus bradycardia in 17, and complete AVB in 5 patients. Conclusion: Mad honey poisoning is an important, life-threatening issue in the Black Sea region of Turkey. Mad honey intoxication should be considered in the differential diagnosis in emergency cases of bradycardia and hypotension.