Mad Honey and the Heart: A Case Report of Transient Bradycardia and Hypotension from Nepal

Background Consuming honey contaminated with grayanotoxins, which are derived from specific Rhododendron species (known locally as Laliguras) found in Nepal's hilly and Himalayan regions, can result in mad honey poisoning. There are plants with high concentrations of Grayanotoxin in a number of places across the world, including Brazil, Japan, Nepal, Turkey, and North America. Case presentation We documented the case of a 59-year-old male exhibiting acute nausea, recurrent vomiting, dizziness, hypotension (BP 60/40 mmHg), and bradycardia (42 bpm) approximately 60-80 minutes following the consumption of 3-4 teaspoons of locally sourced “mad honey.” There is no history of substance abuse, abnormal movement, dyspnea, or chest pain. He was awake, fully conscious, and had no other problems with his body. The electrocardiogram showed sinus bradycardia with no ischemic changes, and the cardiac enzymes were normal. Other possible causes, such as myocardial infarction, hypovolemia, sepsis, beta-blocker overdose, and organophosphate poisoning, were ruled out. A diagnosis of mad honey (grayanotoxin) poisoning was established due to the typical clinical symptoms and a history of honey consumption. The patient received intravenous fluids and atropine, resulting in quick stabilization of vital signs. He maintained stability throughout 24 hours of observation and was discharged with advice to refrain from consuming wild or unprocessed honey. This situation highlights the importance of recognizing mad honey poisoning as a reversible factor for bradycardia and hypotension. Conclusion Although rare, mad honey poisoning can rapidly trigger bradycardia, low blood pressure, and digestive discomfort. With early recognition and timely care, including fluids and atropine, patients typically make a full recovery. Clinicians should stay alert to this possibility, particularly in areas where wild honey is traditionally consumed. Awareness is crucial in regions where wild honey is consumed.