Mad honey poisoning with cardiac and neural manifestation - a rare case report from Western Nepal

Sep 29, 2026

Mad honey poisoning caused by grayanotoxin is presented through a rare case from Western Nepal. The report describes a 20-year-old man without known comorbidities who accidentally ingested wild honey and rapidly developed dizziness, nausea, bradycardia, syncope-related features, and multiple brief generalized tonic spasm episodes. Clinical assessment and laboratory and ECG findings supported the diagnosis after alternative causes were considered and metabolic abnormalities were ruled out. Supportive ICU care stabilized the patient within 24 hours, emphasizing early detection to prevent life-threatening cardiac and CNS complications.

LanguageEnglish

CategoryHealthcare

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Pages4

Reading Time10 min

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Case Report

Introduction

HIGHLIGHTS

Case Presentation

Investigations, Diagnosis, and Treatment

# Case Report Mad honey poisoning with cardiac and neuralmanifestation – a rare case report from WesternNepal UjwalSah, MBBS, Saurav Shah, MBBS*, Aaditya Bhardwaj, MBBS, Arun K. Yadav, MBBS, Aryan Mishra, MBBS,Ayush Jha, MBBS Introduction: Mad honey poisoning is caused due to presence of grayanotoxin. Grayanotoxin interferes with depolarization ofcardiac and nervous tissue resulting in symptoms like dizziness, bradycardia, and syncope. Here the author presents a case reportof mad honey poisoning reported in Western region of Nepal. Case presentation: The author reports a case of 20-year-male with no known prior co-morbidities who accidently ingested wildhoney and thereafter developed cardiac and neural symptoms like dizziness, nausea, bradycardia with multiple brief episodes ofgeneralized tonic spasm. There was no past or family history of allergic reaction to honey or pollen. Discussion: Symptoms experienced by the patient was managed primarily in Emergency department and then further evaluationand management is done in ICU. Diagnosis was established based on the occurrence of symptoms following consumption ofhoney and laboratory data. No definite diagnosis of grayanotoxin can be done due to lack of commercially available detection test.Patient gets stabilized after 24 hours of supportive care in ICU. Conclusion: This case report aims at early detection of mad honey poisoning so that timely intervention can be done and furthercomplications can be prevented. Thus, it helped in reducing morbidity and mortality mostly atthe region where itis highly prevalent.Keywords: bradycardia, case report, grayanotoxin, mad honey, poisoning ## Introduction Honey is widely used in Nepal for feeding purpose and in Herbalmedicine since ancient times. Contamination of honey withgrayanotoxin is very rare which is the reason for “Mad HoneyPoisoning.” The pathogenesis of toxin is explained by its tendencyto block sodium channels of excitable neural and cardiac musclecells which is responsible for cardiac effects like bradycardia,asystole, cardiac arrest, and CNS disorders like convulsion andsyncope[1] . Here, the author presents a case of 20-year-male whohad consumed wild honey and has come to Hospital with cardiacand CNS features. This case report has been reported inline withthe SCARE 2025 and CARE checklists[2,3] . Department of Internal Medicine, Manipal College of Medical Sciences, Pokhara,Nepal Sponsorships or competing interests that maybe relevant to the content aredisclosed atthe end of this article. *Corresponding author. Address: Department of Internal Medicine, Manipal Collegeof Medical Sciences, Phulbari-11, Pokhara, Kaski 33700, Nepal. Tel.: +977-9860970868. E-mail: shahsaurav15rsrh@gmail.com (S. Shah).Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. This is anopen access article distributed under the terms of the Creative CommonsAttribution-Non Commercial License 4.0 (CCBY-NC), where itis permissible todownload, share, remix, transform, and buildup the work provided itis properlycited. The work cannot be used commercially without permission from the journal. Annals of Medicine & Surgery (2026) 88:795–798Received 30 July 2025; Accepted 31 October 2025Published online 17 November 2025http://dx.doi.org/10.1097/MS9.0000000000004314 ## HIGHLIGHTS ● Grayanotoxin, a component of mad honey poisoning pri -marily affects sodium channels of cardiac and nervoustissue. ● Mad honey causes symptoms like bradycardia, syncope,and can cause fatal symptoms like asystole, cardiac arrest. ● Diagnosis and timely intervention can prevent potentiallife-threatening complications. ## Case Presentation A 20-year-old male with no known co-morbidities presented toEmergency department; 2 hours after consumption of 20-30 mlof wild honey when he developed nausea, dizziness, decreasedresponsiveness lasting for 1 min followed by single episode ofvomiting. After 5 hours of ingestion, the developed burningsensa

FAQs

What causes mad honey poisoning in this case report?

Mad honey poisoning is caused by grayanotoxin, which interferes with depolarization in cardiac and nervous tissue, leading to dizziness, bradycardia, and syncope-related symptoms.

What symptoms did the patient develop after ingesting wild honey?

The patient developed nausea, dizziness, decreased responsiveness, vomiting, burning sensation in the abdomen, shortness of breath, and multiple brief generalized tonic spasm episodes, along with sinus bradycardia on ECG.

How was the diagnosis and treatment managed, given the lack of a specific toxin test?

Diagnosis was established from the timing of symptoms after honey ingestion and supporting laboratory data. Treatment relied on supportive ICU management including IV fluids, atropine, a PPI, and anti-emetic agents until stabilization within 24 hours.

Sep 29, 2026

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