Wild honey grayanotoxin intoxication in rural Himalayan region of Nepal: a case report.

Introduction and importance: Wild honey from Nepal's Himalayas contains grayanotoxin, derived from rhododendron flowers, and is used in alternative medicine. However, it can cause severe side effects like vomiting, hypotension, and bradycardia. Case presentation: A 52-year-old baker from Chame, Manang, Nepal experienced dizziness, vomiting, sweating, and hypersalivation 30 minutes after consuming a teaspoon of wild honey for mild abdominal pain. In the emergency department, he had severe dizziness, low blood pressure of 48/32 mm Hg, heart rate of 49 beats per minute, and oxygen saturation of 90%. Electrocardiogram showed sinus bradycardia. He received IV fluids, oxygen, ondansetron, and atropine, with low-dose vasopressor support. His condition gradually improved, and he was discharged with stable vitals follow-up showed stable vitals and no symptoms. Clinical discussion: Consumption of honey containing grayanotoxins, derived from rhododendron plants, can lead to wild honey intoxication, prevalent in regions such as Turkey, South Korea, and Nepal. Symptoms include dizziness, hypotension, bradycardia, and cardiac disturbances. Diagnosis is clinical with use of laboratory tests to rule out other differentials if available and treatment involves symptomatic care with fluids, atropine, and monitoring. Distinguishing mad honey intoxication from conditions like acute coronary syndromes and organophosphate poisoning is crucial. Conclusion: Wild honey intoxication from rhododendron grayanotoxins causes symptoms such as dizziness, hypotension, and bradycardia, requiring clinical diagnosis and management with symptomatic care, fluids, and atropine, along with close monitoring for recovery.