grayanotoxin-i and Hypotension

Many plants of the Ericaceae family, Rhododendron, Pieris, Agarista and Kalmia, contain diterpene grayanotoxins. Consumption of grayanotoxin containing leaves, flowers or secondary products as honey may result in intoxication specifically characterized by dizziness, hypotension and atrial-ventricular block. Symptoms are caused by an inability to inactivate neural sodium ion channels resulting in continuous increased vagal tone. Grayanotoxin containing products are currently sold online, which may pose an increasing risk. In humans, intoxication is rarely lethal, in contrast to cattle and pet poisoning cases. Scientific evidence for the medicinal properties of grayanotoxin containing preparations, such as honey or herbal preparation in use in folk medicine, is scarce, and such use may even be harmful.

Topics: Animals; Atrioventricular Block; Cattle; Diterpenes; Dizziness; Food Contamination; Honey; Humans; Hypotension; Plant Extracts; Plants, Toxic; Rhododendron; Toxins, Biological

The purpose of this study was to investigate grayanotoxin (GTX) levels in the blood of patients with GTX intoxication and in the consumed Rhododendron liqueur, and to determine whether there was an association between blood GTX level and the patient's clinical status.. In September 2015, six patients were concurrently presented to the emergency department with various toxicity symptoms, which occurred after the consumption of Rhododendron liqueur at the same toxin concentration. Liquid chromatography-tandem mass spectrometry analysis was conducted on blood samples obtained from six cases of GTX intoxication treated in our emergency department.. At the initial evaluation in the emergency department, the mean arterial pressure of the patients ranged from 36.7 to 76.7 mm Hg. The concentrations of GTX-I and GTX-III in Rhododendron liqueur were 1.436 and 16.907 ng/mL, respectively. The initial blood GTX-III and GTX-I levels ranged from 2.9 to 58.0 ng/mL and the lower limit of quantification (LLOQ) to 8.33 ng/mL, respectively. After 20 h, the mean arterial pressure ranged from 76.7 to 93.3 mm Hg, while the blood GTX-III and GTX-I levels ranged from the LLOQ to 17.8 and 2.52 ng/mL, respectively.. We estimated that the minimum blood GTX-III and GTX-I levels that caused hypotension were between 17.83 and 27.3 ng/mL, and 2.52 and 4.55 ng/mL, respectively.

Topics: Adult; Biomarkers; Blood Pressure; Chromatography, Liquid; Diterpenes; Female; Humans; Hypotension; Male; Middle Aged; Plant Extracts; Plant Leaves; Poisoning; Retrospective Studies; Rhododendron; Tandem Mass Spectrometry

A 52-year-old man with Turkish background presented with nausea, emesis, one experience of syncope with loss of consciousness for a few seconds, and documented sinus bradycardia. During monitoring, several phases of bradycardia were observed. After 24 h of monitoring, the patient was free of complaints. The patient's wife reported regular consumption of pontin honey. Because of the anamnesis and the typical characteristics, grayanotoxin poisoning was diagnosed. Typical symptoms of this poisoning are hypotension, bradycardia, syncope, and loss of consciousness. When these symptoms are found and a typical anamnesis exists, this kind of intoxication has to been taken into consideration as part of the differential diagnosis.

Topics: Bradycardia; Diagnosis, Differential; Diterpenes; Dyspnea; Electrocardiography; Emigrants and Immigrants; Foodborne Diseases; Germany; Honey; Humans; Hypotension; Male; Middle Aged; Sinus Arrest, Cardiac; Syncope; Turkey

Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Atropine; Bed Rest; Bradycardia; Diterpenes; Electrocardiography; Fluid Therapy; Honey; Humans; Hypotension; Male; Middle Aged; Rhododendron; Sodium Channels; Stomach Ulcer; Turkey

"Mad honey" poisoning occurs from ingestion of honey produced from grayanotoxin-containing nectar, often in the setting of use as an alternative medicine. This study is designed to assess the clinical effects, demographics, and rationale behind self-induced mad honey poisoning.. The study consisted of 2 components: a standardized chart review of the signs, symptoms, and treatment of patients with mad honey ingestion, treated in our emergency department between December 2002 and January 2008; and a cross-sectional survey of a convenience sample of beekeepers specializing in the production and distribution of mad honey.. We identified 21 cases. Patients were overwhelmingly men (18/21) and older (mean [SD]), 55 [11] years. Local beekeepers (N=10) ranked sexual performance enhancement as the most common reason for therapeutic mad honey consumption in men aged 41 through 60 years. Symptoms began 1.0 hour (SD 0.6 hour) after ingestion and included dizziness, nausea, vomiting, and syncope. Abnormal vital signs included hypotension (mean arterial pressure 58 mm Hg [SD 13 mm Hg]) and bradycardia (mean 45 beats/min [SD 9 beats/min]). Seventeen patients had sinus bradycardia and 2 had junctional rhythm. Nine patients were treated with atropine; 1 patient received dopamine. All patients were discharged 18 to 48 hours after admission.. A dietary and travel history should be included in the assessment of middle-aged men presenting with bradycardia and hypotension. A mad honey therapeutic misadventure may be the cause rather than a primary cardiac, neurologic, or metabolic disorder.

Topics: Adult; Biological Therapy; Bradycardia; Cross-Sectional Studies; Diterpenes; Erectile Dysfunction; Female; Honey; Humans; Hypotension; Male; Middle Aged; Neuromuscular Depolarizing Agents

An unusual type of food poisoning is commonly seen in the Black Sea coast of Turkey due to grayanotoxin containing toxic honey so called "mad honey" ingestion. In cases of toxication bradycardia and rhythm disturbances are commonly observed. Herein, we present a case of a patient who was admitted to the hospital because of acute myocardial infarction with normal coronary arteries after "mad honey" ingestion.

Topics: Aged; Angina Pectoris; Bradycardia; Diterpenes; Foodborne Diseases; Honey; Humans; Hypotension; Male; Myocardial Infarction; Rhododendron; Risk Factors; Toxins, Biological; Turkey

Honey intoxication, a kind of food poisoning, can be seen in the Black Sea region of Turkey and in various other parts of the world as well. In this study, 66 patients were hospitalized with a variety of symptoms including nausea, vomiting, salivation, dizziness, weakness, hypotension, bradycardia and syncope several hours after the ingestion of small amounts of honey. All patients had hypotension, and majority had bradycardia. These features resolved completely in 24 h with i.v. fluids and atropine, and none died. In conclusion, honey poisoning should be taken into consideration in the differential diagnosis of acute myocardial infarction and in the patients with vomiting, hypotension and bradycardia.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Atropine; Bradycardia; Diterpenes; Female; Fluid Therapy; Honey; Humans; Hypotension; Male; Middle Aged; Plants, Toxic; Syncope

Grayanotoxin intoxication, which is mostly seen in the eastern Black Sea region of Turkey, stems from the "mad honey" made by bees from the rhododendron plant flowers. In low doses, this causes dizziness, hypotension, and bradycardia, and in high doses, impaired consciousness, seizures, and atrioventricular block (AVB). This case study was designed as a series of cases of patients (6 women, 2 men) aged between 35 and 75 years. All of the patients' physical examinations revealed hypotension; 4 patients had sinus bradycardia, 3 had nodal rhythm, and 1 had complete AVB. In all patients, except for the patient with AVB, heart rate and blood pressure returned to normal limits within 2 to 6 hours. Two patients were monitored in the coronary intensive care unit. Of these 2, 1 was discharged on the second day. The other was fitted with a temporary pacemaker and was discharged on the third day. All the other patients were kept in for a 6-hour observation period and were then discharged from the ED. To date, 58 such cases have been reported, but we saw 8 patients within 2005. It is commonly seen in the east of the Black Sea region, although cases may occur from all over the eastern Black Sea region of Turkey. So far, no cases of death have been reported, although grayanotoxin causes adverse effects on the cardiovascular and respiratory systems and is therefore of considerable importance.

Topics: Adult; Aged; Antihypertensive Agents; Bradycardia; Diterpenes; Female; Foodborne Diseases; Honey; Humans; Hypotension; Male; Middle Aged; Rhododendron; Turkey

Grayanotoxins are known to occur in the honey produced from the nectar of Rhododendron ponticum growing on the mountains of the eastern Black Sea region of Turkey and also in Japan, Nepal, Brazil, and some parts of North America and Europe. Two cases of honey intoxication are presented here. Both of the patients experienced severe bradycardia and hypotension after ingestion of honey which was brought from Trabzon, Turkey. Microscopical examination showed Rhododendron ponticum pollen tetrades. Anesthetized albino rats were injected intraperitoneally with toxic honey extract doses equivalent to 1 or 5 g honey/kg. Dose-dependent hypotension, bradycardia and respiratory rate depression were observed. When marked bradycardia (approximately 75% of control value) was reached, rats were given atropine sulfate (2 mg/kg, i.p.) or AF-DX 116 (20 mg/kg, i.p.). Atropine sulfate improved both bradycardia and respiratory rate depression. AF-DX 116, which is a selective M2-muscarinic receptor antagonist, restored only heart rate, but not the respiratory rate depression. These results suggest that M2-muscarinic receptors are involved in cardiotoxicity of grayanotoxin.

Topics: Aged; Animals; Atropine; Bradycardia; Diterpenes; Female; Honey; Humans; Hypotension; Male; Middle Aged; Parasympatholytics; Pirenzepine; Rats; Respiration; Turkey

Topics: Bradycardia; Diterpenes; History, Ancient; Honey; Humans; Hypotension; Plants, Toxic

Two patients poisoned by andromedotoxin-containing honey were treated in Austrian hospitals in 1981 and 1982. The toxin-containing honey had in both cases been obtained in the coastal mediterranean part of Turkey. Both patients had severe arterial hypotension, bradycardic arrhythmias, syncope and CNS symptoms. Symptomatic treatment was fully successful in both patients within 24 hours.

Topics: Adult; Bradycardia; Diterpenes; Electrocardiography; Female; Honey; Humans; Hypotension; Male; Pacemaker, Artificial

Topics: Blood Pressure; Blood Pressure Determination; Diterpenes; Humans; Hypotension; Pressure; Vasodilator Agents