What is the management of Turkish honey intoxication?

Management of Turkish Honey Intoxication

The management of Turkish honey intoxication primarily involves supportive care with atropine administration as the first-line treatment for bradycardia and hypotension, along with intravenous fluid resuscitation.

Understanding Turkish Honey Poisoning

Turkish honey poisoning, also known as "mad honey" poisoning, occurs from consuming honey containing grayanotoxins (formerly called andromedotoxin). This toxin is found in honey produced from the nectar of Rhododendron species, particularly in the eastern Black Sea region of Turkey. Grayanotoxins increase sodium channel permeability and activate the vagus nerve, leading to cardiac toxicity 1.

Clinical Presentation

• Cardiovascular: Bradycardia, hypotension, syncope, and in severe cases, asystole 2
• Neurological: Dizziness, vertigo, lightheadedness, loss of consciousness 1
• Gastrointestinal: Nausea, vomiting 3
• Other: Sweating, feeling of retrosternal compression 4

Symptoms typically begin within 30-60 minutes of honey ingestion 1.

Treatment Algorithm

1. Initial Assessment and Stabilization

• Secure airway, breathing, and circulation
• Position unconscious patients in left lateral head-down position 5
• Continuous cardiac monitoring due to risk of severe bradyarrhythmias and asystole 2

2. Specific Treatment

• Atropine administration:

  • Adult dose: 0.5-1 mg IV, may be repeated as needed 2, 3
  • Pediatric dose: 0.02 mg/kg 5
  • Titrate to reversal of bradycardia and hypotension

• Intravenous fluid resuscitation:

  • Normal saline bolus for hypotension 1, 3

• Vasopressors (if needed):

  • Dopamine may be required for persistent hypotension despite atropine and fluids 3

3. Cardiac Management

• For severe cases with persistent bradyarrhythmias:
  • Consider temporary cardiac pacing if unresponsive to atropine 2
  • Monitor for potential myocardial infarction, which has been reported in rare cases 6

4. Monitoring and Supportive Care

• Continuous cardiac monitoring for at least 24 hours 5
• Serial assessment of vital signs and mental status
• Monitor for resolution of symptoms, which typically occurs within 24 hours 4

Special Considerations

• Avoid common mistakes:

  • Failing to recognize the condition, especially outside of Turkey
  • Delaying atropine administration in symptomatic bradycardia
  • Discharging patients too early before complete resolution of symptoms

• Laboratory confirmation:

  • Grayanotoxin testing is not typically available in time to guide acute management 1
  • Clinical diagnosis based on history of honey consumption and typical presentation is sufficient to initiate treatment

• Prognosis:

  • Most patients recover completely with supportive care and atropine
  • Fatal outcomes are rare with appropriate treatment 3

When to Consult Poison Control

Contact regional poison centers for expert guidance on management:

• United States: 1-800-222-1222
• Canada: Provincial poison centers (https://infopoison.ca) 5

Most patients with Turkish honey poisoning respond well to atropine and intravenous fluids, with complete recovery within 24 hours without long-term sequelae 3.