Cardiovascular Toxicology

, Volume 16, Issue 1, pp 1–4 | Cite as

Cardiac Effects of Mad Honey Poisoning and Its Management in Emergency Department: A Review from Turkey



Mad honey poisoning occurs when honey containing grayanotoxin is digested. The most common clinical signs and symptoms of poisoning involve findings of digestive system irritation, severe bradycardia and hypotension and central nervous system reaction. In this review, we aimed to underline the cardiac effects of mad honey poisoning. We also aimed to raise the awareness of physicians about early diagnosis and treatment of this rare entity.


Mad honey poisoning Cardiac effects Emergency department 


  1. 1.
    Oguzturk, H., Ciftci, O., Turtay, M. G., & Yumrutepe, S. (2012). Complete atrioventricular block caused by mad honey intoxication. European Review for Medical and Pharmacological Sciences, 16, 1748–1750.PubMedGoogle Scholar
  2. 2.
    Uzun, H., Narci, H., Tayfur, I., Karabulut, K. U., & Karcioglu, O. (2013). Mad honey intoxication: What is wrong with the blood glucose? A study on 46 patients. European Review for Medical and Pharmacological Sciences, 17, 2728–2731.PubMedGoogle Scholar
  3. 3.
    Saritas, A., Kandis, H., Baltaci, D., & Erdem, I. (2011). Paroxysmal atrial fibrillation and intermittent left bundle branch block: An unusual electrocardiographic presentation of mad honey poisoning. Clinics (Sao Paulo), 66, 1651–1653.CrossRefGoogle Scholar
  4. 4.
    Koca, I., & Koca, A. F. (2007). Poisoning by mad honey: A brief review. Food and Chemical Toxicology, 45, 1315–1318.CrossRefPubMedGoogle Scholar
  5. 5.
    Jordan, J. (2006). Research highlights from the literature. Clinical Autonomic Research, 16, 198–201.CrossRefPubMedGoogle Scholar
  6. 6.
    Kan, T., Hosokawa, S., Nara, S., et al. (1994). Total synthesis of (-)-grayanotoxin III. Journal of Organic Chemistry, 59, 5532–5534.CrossRefGoogle Scholar
  7. 7.
    Jansen, S. A., Kleerekooper, I., Hofman, Z. L., Kappen, I. F., Stary-Weinzinger, A., & van der Heyden, M. A. (2012). Grayanotoxin poisoning: ‘Mad honey disease’ and beyond. Cardiovascular Toxicology, 12, 208–215.PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Yaylaci, S., Kocayigit, I., Aydin, E., Osken, A., Genc, A. B., Cakar, M. A., & Tamer, A. (2014). Clinical and laboratory findings in mad honey poisoning: A single center experience. Nigerian Journal of Clinical Practice, 17, 589–593.CrossRefPubMedGoogle Scholar
  9. 9.
    Nakao, M., & Seyama, I. (1984). Effect of a dihydrograyanotoxin II on the electrical activity of the rabbit sinoatrial node. Journal of Physiology, 357, 79–91.PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Cagli, K. E., Tufekcioglu, O., Sen, N., Aras, D., Topaloglu, S., Basar, N., & Pehlivan, S. (2009). Atrioventricular block induced by mad-honey intoxication: Confirmation of diagnosis by pollen analysis. Texas Heart Institute Journal, 36, 342–344.PubMedCentralPubMedGoogle Scholar
  11. 11.
    Gunduz, A., Bostan, H., Turedi, S., Nuhoğlu, I., & Patan, T. (2007). Wild flowers and mad honey. Wilderness and Environmental Medicine, 18, 69–71.CrossRefPubMedGoogle Scholar
  12. 12.
    Gunduz, A., Durmus, I., Turedi, S., Nuhoglu, I., & Ozturk, S. (2007). Mad honey poisoning-related asystole. Emergency Medicine Journal, 24, 592–593.PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Oztasan, N., Altinkaynak, K., Akcay, F., Gocer, F., & Dane, S. (2005). Effects of made honey on blood glucose and lipid levels in rats with Streptozocin-induced diabetes. Turkish Journal of Veterinary and Animal Sciences, 29, 1093–1096.Google Scholar
  14. 14.
    Yarlioglues, M., Akpek, M., Ardic, I., Elcik, D., Sahin, O., & Kaya, M. G. (2011). Mad-honey sexual activity and acute inferior myocardial infarctions in a married couple. Texas Heart Institute Journal, 38, 577–580.PubMedCentralPubMedGoogle Scholar
  15. 15.
    Okuyan, E., Uslu, A., & Ozan Levent, M. (2010). Cardiac effects of “mad honey”: A case series. Clinical Toxicology (Philadelphia), 48, 528–532.CrossRefGoogle Scholar
  16. 16.
    Bostan, M., Bostan, H., Kaya, A. O., Bilir, O., Satiroglu, O., Kazdal, H., et al. (2010). Clinical events in mad honey poisoning: A single centre experience. Bulletin of Environment Contamination and Toxicology, 84, 19–22.CrossRefGoogle Scholar
  17. 17.
    Gunduz, A., Meriçé, E. S., Baydin, A., Topbaş, M., Uzun, H., Türedi, S., & Kalkan, A. (2009). Does mad honey poisoning require hospital admission? American Journal of Emergency Medicine, 27, 424–427.CrossRefPubMedGoogle Scholar
  18. 18.
    Gunduz, A., Turedi, S., Uzun, H., & Topbas, M. (2006). Mad honey poisoning. American Journal of Emergency Medicine, 24, 595–598.CrossRefPubMedGoogle Scholar
  19. 19.
    Gunduz, A., Kalkan, A., Turedi, S., Durmus, I., Turkmen, S., Ayaz, F. A., & Ayar, A. (2012). Pseudocholinesterase levels are not decreased in grayanotoxin (mad honey) poisoning in most patients. Journal of Emergency Medicine, 43, 1008–1013.CrossRefPubMedGoogle Scholar
  20. 20.
    Osken, A., Yaylacı, S., Aydın, E., Kocayigit, I., Cakar, M. A., Tamer, A., & Gündüz, H. (2012). Slow ventricular response atrial fibrillation related to mad honey poisoning. Journal of Cardiovascular Disease research, 3, 245–247.PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Bayram, N. A., Keles, T., Durmaz, T., Dogan, S., & Bozkurt, E. (2012). A rare cause of atrial fibrillation: Mad honey intoxication. Journal of Emergency Medicine, 43, 389–391.CrossRefGoogle Scholar
  22. 22.
    Sumerkan, M. C., Agirbasli, M., Altundag, E., & Bulur, S. (2011). Mad-honey intoxication confirmed by pollen analysis. Clinical Toxicology (Philadelphia), 49, 872–873.CrossRefGoogle Scholar
  23. 23.
    Sayin, M. R., Dogan, S. M., Aydin, M., & Karabag, T. (2011). Extreme QT interval prolongation caused by mad honey consumption. Canadian Journal of Cardiology, 27(870), 17–19.Google Scholar
  24. 24.
    Aliyev, F., Türkoglu, C., & Celiker, C. (2009). Nodal rhythm and ventricular parasystole: An unusual electrocardiographic presentation of mad honey poisoning. Clinical Cardiology, 32, 52–54.CrossRefGoogle Scholar
  25. 25.
    Dubey, L., Maskey, A., & Regmi, S. (2009). Bradycardia and severe hypotension caused by wild honey poisoning. Hellenic Journal of Cardiology, 50, 426–428.PubMedGoogle Scholar
  26. 26.
    Seyama, I., Yamaoka, K., Yakehiro, M., Yoshioka, Y., & Morihara, K. (1985). Is the site of action of grayanotoxin the sodium channel gating of squid axon? Japanese Journal of Physiology, 35, 401–410.CrossRefPubMedGoogle Scholar
  27. 27.
    Eller, P., Hochegger, K., Tancevski, I., Pechlaner, C., & Patsch, J. R. (2008). Sweet heart block. Circulation, 118, 319.CrossRefPubMedGoogle Scholar
  28. 28.
    Weiss, T. W., Smetana, P., Nurnberg, M., & Huber, K. (2008). The honey man–second degree heart block after honey intoxication. International Journal of Cardiology, 142, 6–7.CrossRefGoogle Scholar
  29. 29.
    Gunduz, A., Tatli, O., & Turedi, S. (2008). Mad honey poisoning from the past to the present. Turkish Journal of Emergency Medicine, 8, 46–49.Google Scholar
  30. 30.
    Sohn, C. H., Seo, D. W., Ryoo, S. M., Lee, J. H., Kim, W. Y., Lim, K. S., & Oh, B. J. (2014). Clinical characteristics and outcomes of patients with grayanotoxin poisoning after the ingestion of mad honey from Nepal. Internal and Emergency Medicine, 9, 207–211.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Emergency MedicineSamsun Education and Research HospitalSamsunTurkey

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