Grayanotoxin levels in blood, urine and honey and their association with clinical status in patients with mad honey intoxication

Aim: Grayanotoxin-containing honey produced by bees fed on nectars from the plants Rhododendron ponticum and Rhododendron luteum is known in Turkey as 'Mad Honey' or 'Rose of the Forest Honey.' No studies have shown the level of toxin in both honey and the body fluids of affected individuals in intoxications caused by rose of the forest honey. The purpose of this study was to investigate whether there is an association between grayanotoxin levels in urine and blood of patients with mad honey intoxication and in the honey consumed, and the resulting clinical picture. Method: Twenty-five cases diagnosed with mad honey intoxication at a university hospital emergency department between September 2013 and February 2015 were included in the study. Samples of mad honey consumed by patients were obtained. Blood and urine specimens were collected at presentation to the emergency department. Clinical data at time of presentation were entered onto study forms. GTX 1 and GTX 3 levels from patients' blood and urine and from honey consumed were investigated simultaneously using the LC-MS/MS system. Results: Dizziness was observed in 60% of patients, nausea in 56%, vomiting in 28% and syncope in 44%. Mean systolic blood pressure (SBP) was 85.40 mmHg, diastolic blood pressure 51.60 mmHg and heart rate 43/min. Mean GTX 1 concentration in blood was 4.82 ng/mL and mean GTX 3 level 6.56 ng/mL. Mean GTX concentration in urine was 0.036 g/mL and mean GTX 3 level 0.391 g/mL. Mean GTX I concentration in honeys consumed was 8.73 g/gr and mean GTX 3 level 27.60 g/gr. No statistically significant correlation was determined between GTX levels in urine and blood or in honey consumed in patients with SBP≤90 mmHg or SBP>90 mmHg. No correlation was also determined between GTX levels in urine and blood or in honey consumed in patients with heart rate <50/min. No GTX 3 was detected in any patient with heart rate ≥50/min (p=0.00). Conclusion: This descriptive study is the first to show grayanotoxin levels in body fluids of patients with mad honey intoxication. No association was determined between grayanotoxin levels in blood and clinical data.