Analysis of mad honey (GRAYANOTOKSİN) cases admitted to Duzce University school of medicine emergency department

Mad honey is the type of honey made by bees that are nourished from the plants of Rhododendron (Rh.) family, and it contains grayanotoksin (GTX). It is also named as bitter honey. The honey is commonly seen in Turkey and Rh family has more than 750 types in various regions of the world including Spain, Portuguese, Japan and Brazil. The most significant types of Rh family, which contain GTX, are Rh. Ponticum and Rh. Flavum and found in the parts of mountains towards the sea along the Black Sea coast in Turkey. Today, mad honey is used as an alternative medicine cure. Having more than one tea spoon of the honey may cause intoxication symptoms. This type of intoxication may cause blackout, muscle relaxation; and even death because of significant blood pressure and pulse drops is also a possible outcome. In order to analyze the results of a possible overdose, we evaluated the patients taken to the emergency deparment after eating mad honey and falling sick. In this study, cases who came to the emergency room because of GTX intoxication are analyzed in detail in order to help diagnosis, treatment, follow-up and prognosis in daily emergency medicine practice. A total of 36 patients, who came to Düzce University Research and Education Hospital Emergency Deparment between 03.01.2015 and 03.01.2016 with the symptoms and diagnosis of intoxication after consuming mad honey, were included in the study. Ten healthy induviduals who did not have a history of taking mad honey were included in the control group. The study is designed as a prospective case control study. GTX and standard biochemical parameters were examined in patients' venous blood samples. All data were compared with control group and the significance of these data was evaluated by various statistical tests. The average GTX level of the group who ate mad honey (study group) was 7, 88 ng/ml (min: 0,00 / max: 30,47). At control group, GTX level was 0 ng/ml. The difference of GTX level between the study group and the control group was statistically significant. There was no statistically significant relationship between the symptoms like dizziness, nausea, vomiting, weakness, deterioration, angina and blood GTX level. According to our study there was a relationship between kidney function tests (urea, creatinin and BUN) and troponin and control troponin levels. The patients who have absolute decrease in blood pressure and pulse should be questioned by emergency medicine doctors about consuming mad honey; because even though the patients claim that they did not eat mad honey, in some situations, we may care acress the result and symptoms of GTX poisoning. The amount of mad honey should not only be illustrated with symptoms, but olso considered that the plants that the bees feed on and seasonel conditions and even the smallest amount of mad honey may cause a serious poisoning findings. Further studies are needed to demonstrate the relationship between symptoms and GTX poisoning. By this way we can reach more meaningful results.