Mad Honey Poisoning Caused by Grayanotoxin Toxicity in a 75-Year-Old Male Patient Presenting With Hypotension and Bradycardia in the United Kingdom: A Case Report.

Mad honey contains the neurotoxin grayanotoxin, which is produced by the flowers and nectar of the Rhododendron family. Bees incorporate this toxin into honey. Mad honey is consumed as a medicinal remedy in certain parts of the world, leading to persistent vagal activation and potentially serious complications, including hemodynamic instability. We report the case of a 75-year-old male patient with a medical history of hyperlipidemia and hypertension (managed with atorvastatin 20 mg and amlodipine 5 mg, respectively) who presented to the emergency department complaining of near-syncope, dizziness, lethargy, nausea, and one episode of diarrhea one hour after ingesting 20-30 mL of wild honey brought as a gift from abroad. On presentation, he was conscious and alert. Triage observations revealed a blood pressure of 65/41 mmHg, a heart rate of 45 beats/minute, a respiratory rate of 20 breaths/minute, an oxygen saturation of 98% on room air, and a temperature of 36.8°C. Physical examination was unremarkable. Electrocardiogram demonstrated sinus bradycardia. The patient was resuscitated with intravenous fluids and 0.6 mg of intravenous atropine, which normalized his heart rate and blood pressure within seconds. He was admitted for observation for 36 hours and was discharged without sequelae. Mad honey poisoning is rare in the United Kingdom and requires a high index of suspicion. Symptoms of hypotension and bradycardia following honey consumption should alert clinicians to this poisoning. Treatment with atropine is successful in alleviating symptoms, which typically resolve within 24 hours.