Abstract
Background
Human grayanotoxin poisoning is distinctly uncommon in North America, as the predominant
source of human exposure is honey made by bees pollinating rhododendron species in
the Mediterranean. We present a case of confirmed grayanotoxin poisoning from honey
imported from Turkey.
Case Report
A 61-year-old man developed nausea, lightheadedness, and lost consciousness. Onset
was 30 min after the ingestion of honey that was brought to the United States from
Turkey. Emergency medical services found him bradycardic, hypotensive, and unresponsive.
He was treated with atropine, saline, and oxygen, at which point his heart rate and
blood pressure improved, and he regained consciousness. A similar episode several
days earlier was followed by a brief unrevealing hospitalization. He was again hospitalized,
and had a normal echocardiogram, telemetric monitoring, and complete laboratory studies.
Grayanotoxins I and III were subsequently identified in the patient's blood, urine,
and honey.
Why Should an Emergency Physician Be Aware of This?
Grayanotoxins are diterpenoids found in rhododendron species, whose clinical effects
span multiple organ systems including gastrointestinal, cardiac, and neurologic. Treatment
is largely supportive, and a good response to atropine and intravenous fluids has
been described. Laboratory confirmation of grayanotoxins is not available in a short
enough turnaround time to be clinically useful during immediate management, but confirmatory
testing may obviate further unnecessary evaluation. Grayanotoxins are likely to remain
a rare source of poisoning in North America, but recurrent bradycardia without alternative
etiology should prompt a thorough exposure history, which may reveal, as in this case,
a treatable toxicologic etiology.
Keywords
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Article info
Publication history
Published online: May 12, 2022
Accepted:
May 9,
2022
Received in revised form:
April 1,
2022
Received:
September 19,
2021
Footnotes
Reprints are not available from the authors.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
