Saritas, Ayhan/0000-0002-4302-1093; Saritas, Ayhan/0000-0002-4302-1093; Kandis, Hayati/0000-0001-9151-6050WOS: 000297498400025PubMed: 22179175

Baltaci, Davut

Erdem, Ismail

Kandis, Hayati

Saritas, Ayhan

Clinics

English

PubMed

Sarıtaş, Ayhan

Kandiş, Hayati

Baltacı, Davut

Erdem, İsmail

Duzce University Open Access

Paroxysmal atrial fibrillation and intermittent left bundle branch block: an unusual electrocardiographic presentation of mad honey poisoning

Cadernos Espinosanos (E-Journal)

CASE REPORTParoxysmal atrial fibrillation and intermittent leftbundle branch block: an unusualelectrocardiographic presentation of mad honeypoisoningAyhan Saritas,I Hayati Kandis,I Davut Baltaci,II Ismail ErdemIIIIDuzce University School of Medicine, Department of Emergency Medicine, Duzce, Turkey. IIDuzce University School of Medicine, Department of FamilyMedicine, Duzce, Turkey. IIIDuzce University School of Medicine, Department of Cardiology, Duzce, Turkey.Email: a_saritas_@hotmail.comTel.: 0 380 5421390/5820INTRODUCTIONMad honey poisoning occurs through the intake of honeymade from the nectar of Rhododendron species containinggrayanotoxins, a family of lipid-soluble toxins responsiblefor the clinical manifestations of mad honey intoxicationsyndrome. These plants grow in the eastern parts of theBlack Sea region of Turkey and in various other parts of theworld (e.g., South America, Europe, and Japan).1 Previousreports concerning mad honey poisoning have generallydescribed various degrees of atrioventricular (AV) block,sinus bradycardia, asystole, nodal rhythm with ventricularparasystole, and even acute myocardial infarction.2,3 Thediagnosis is often made based on a history of honey intake.We report a unique case of a patient who presentedparoxysmal atrial fibrillation and intermittent left bundlebranch block related to mad honey poisoning.CASE REPORTA 70-year-old man was admitted to our emergencydepartment with weakness, palpitation, nausea and vomit-ing that arose from eating a few teaspoons of mad honey.He did not have any cardiovascular or systemic disease andwas not taking any medication. On physical examination, hewas confused, his blood pressure was 60/20 mmHg, and hisheart rate was 105 beats/min. The neurological examinationwas normal. Upon admission, his electrocardiographyrevealed paroxysmal atrial fibrillation and intermittent leftbundle branch block (Figure 1). There was no structuralcardiac abnormality found from transthoracic echocardio-graphy. His hypotension improved rapidly after salineinfusion. During observation, his rhythm returned to anormal sinus rhythm six hours after admission (Figure 2),and he was discharged on the second day of his hospitalstay.DISCUSSIONGrayanotoxins are responsible for the clinical manifesta-tions of mad honey poisoning. These toxins bind to sodiumchannels in the cell membrane, increasing the permeabilityof these channels and are thus responsible for inotropy. Thesigns and symptoms generally may occur within minutesand to up to two hours or more after ingestion.1,4,5 Well-known clinical manifestations of mad honey poisoninginclude hypotension, bradycardia, arrhythmia, loss ofconsciousness, weakness, nausea, and vomiting. To the bestof our knowledge, no case of paroxysmal atrial fibrillationand intermittent left bundle branch block associated withmad honey poisoning has previously been reported.CONCLUSIONWe report a case of a 70-year-old man with severehemodynamic instability following the ingestion of madhoney and his unusual electrocardiographic manifestations:paroxysmal atrial fibrillation and intermittent left bundlebranch block.REFERENCES1. Gunduz A, Bostan H, Turedi S, Nuhog˘lu I, Patan T. Wild flowers andmad honey. Wilderness Environ Med. 2007;18:69–71, doi: 10.1580/06-WEME-LE-042R.1.2. Aliyev F, Tu¨rkoglu C, Celiker C. Nodal rhythm and ventricularparasystole: an unusual electrocardiographic presentation of mad honeypoisoning. Clin Cardiol. 2009;32:52-54, doi: 10.1002/clc.20438.3. Akinci S, Arslan U, Karakurt K, Cengel A. An unusual presentation ofmad honey poisoning: acute myocardial infarction. Int J Cardiol.2008;129:56-8, doi: 10.1016/j.ijcard.2007.06.129.4. Gunduz A, Turedi S, Uzun H, Topbas M. Mad honey poisoning.Am J Emerg Med. 2006;24:595–8, doi: 10.1016/j.ajem.2006.01.022.5. Yilmaz O, Eser M, Sahiner A, Altintop L, Yesildag O. Hypotension,bradycardia and syncope caused by honey poisoning. Resuscitation.2006;68:405–8, doi: 10.1016/j.resuscitation.2005.07.014.Copyright  2011 CLINICS – This is an Open Access article distributed underthe terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided theoriginal work is properly cited.CLINICS 2011;66(9):1651-1653 DOI:10.1590/S1807-593220110009000251651Figure 1 - Paroxysmal atrial fibrillation and intermittent left bundle branch block upon admission.Mad Honey PoisoningSaritas A et al.CLINICS 2011;66(9):1651-16531652Figure 2 - Normal sinus rhythm 6 hours after admission.CLINICS 2011;66(9):1651-1653 Mad Honey PoisoningSaritas A et al.1653

Ayhan Saritas

Hayati Kandis

Davut Baltaci

Ismail Erdem

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An unusual presentation of mad honey poisoning: acute myocardial infarction.

bradycardia and syncope caused by honey poisoning.

Mad honey poisoning.

Nodal rhythm and ventricular parasystole: an unusual electrocardiographic presentation of mad honey poisoning. Clin Cardiol.

Wild flowers and mad honey. Wilderness Environ Med.

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Paroxysmal atrial fibrillation and intermittent left bundle branch block: an unusual electrocardiographic presentation of mad honey poisoning

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