{"paper_id":"0bf2459f-bbf6-4efb-bccf-323b02201c84","body_text":"Mad Honey and the Heart: A Case Report of Transient Bradycardia and Hypotension from Nepal | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Mad Honey and the Heart: A Case Report of Transient Bradycardia and Hypotension from Nepal Nabin Pahari, Mukesh Pahari, Sagun Ghimire, Bharat Khatri, Rajesh Yadav, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8005869/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Mar, 2026 Read the published version in International Journal of Emergency Medicine → Version 1 posted 13 You are reading this latest preprint version Abstract 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. Bradycardia Case report Grayanotoxin Honey Nepal Rhododendron Figures Figure 1 Figure 2 Background Recent studies emphasize honey's role as a healing substance with notable antibacterial, antiviral, and antifungal effects. These impacts are mainly due to its acidic pH and enzymatic function, allowing honey to prevent the proliferation of microorganisms and aid in their elimination. [ 1 ]. Mad honey poisoning occurs due to ingesting honey tainted with grayanotoxin, a neurotoxin sourced from specific Rhododendron species in the hilly and Himalayan areas of Nepal. The world's largest honey bee species, the Himalayan giant honey bee (Apis laboriosa), can reach lengths of up to 3.0 cm. This species produces mad honey in the high-altitude areas of Nepal by gathering nectar from Rhododendron species that contain grayanotoxins [ 2 ]. Various areas globally, including Turkey, Japan, Nepal, North America, and Brazil, contain plants with significant amounts of grayanotoxins, potentially causing honey poisoning [ 3 , 4 ]. The first recorded instances of extensive mad honey poisoning are traced to 401 BC, as detailed by the military leader Xenophon in his writings, Anabasis. Historically, mad honey has served as an aphrodisiac and a natural treatment for digestive issues like peptic ulcers, gastritis, and dyspepsia, along with intestinal disorders, arthritis, skin ailments, colds, and high blood pressure [ 5 ]. Buratti et al. found that mad honey exhibits the highest antioxidant activity compared to other honey varieties. Mad honey is utilized as a weapon as well [ 6 , 7 , 8 , 9 , 10 ]. Case presentation A 59-year-old male arrived at the emergency room with chief complaints of nausea, several instances of vomiting, and feelings of dizziness. He stated that these symptoms appeared suddenly around 60–80 minutes after he ingested 3–4 teaspoons (roughly 15–20 ml) of locally sourced \"mad honey”. He refused any loss of awareness, convulsions, diarrhea, chest discomfort, or trouble breathing. During the presentation, he was attentive and completely aware of the time, location, and person. He had a known diagnosis of COPD for which he used one rota inhaler of Salmeterol and fluticasone and one rota inhaler of Tiotropium bromide daily. He had no documented history of heart disease and was not using any heart-related medications. There is no record of substance use, no unusual movement, shortness of breath, or chest discomfort. Upon examination, the patient looked uneasy and frail but stayed compliant. His blood pressure measured 60/40 mmHg, and his heart rate was 42 beats per minute. He was breathing easily at 17 breaths per minute, exhibiting a normal temperature and an oxygen saturation of 95% while on room air. Cardiovascular assessment showed significant bradycardia with no unusual heart sounds present. Auscultation showed clear lungs, the abdomen was non-tender and soft, and the neurological exam indicated no deficits. The diagnosis for this patient was primarily based on the distinct history of consuming mad honey, which was soon followed by symptoms including nausea, vomiting, dizziness, hypotension, and bradycardia. The short interval between eating and the emergence of symptoms strongly indicated grayanotoxin poisoning. Due to the absence of a definitive laboratory test for mad honey intoxication, the diagnosis depended on thorough clinical assessment and ruling out other alternatives. We examined various differentials. Acute myocardial infarction was improbable since the patient experienced no chest pain, his cardiac enzymes were within normal limits, and the ECG displayed only sinus bradycardia without any ischemic alterations (Fig. 1 ). Hypovolemia and sepsis were excluded due to the lack of fluid loss, fever, or infection indicators. A beta-blocker overdose was ruled out as the patient was not taking any such medication, and organophosphate poisoning was considered improbable due to the absence of cholinergic symptoms like excessive salivation, lacrimation, urination, diarrhea, gastrointestinal cramping, vomiting, miosis, bronchorrhea, or bronchospasm. Even though grayanotoxin levels in blood can be measured, there was no any laboratory facility in our hospital or in many hospitals across Nepal. Ultimately, the reliable history of honey consumption, the distinctive clinical presentation, and the thorough elimination of other potential causes resulted in the definitive diagnosis of mad honey (grayanotoxin) poisoning. The patient received immediate treatment with intravenous fluids and a one-time administration of 0.6 mg intravenous atropine. His heart rate and blood pressure progressively improved after treatment, and no further doses of atropine was required. His ECG after atropine is shown in Fig. 2 . He was monitored closely for 24 hours, during which his symptoms disappeared completely and his vital signs became stable. His blood investigations are given in Table 1 . The patient was discharged the next day in stable condition and was advised to refrain from consuming wild or unprocessed honey again. He was requested to follow up after 2 weeks post-discharge. On follow up his basic blood tests and ECG results were normal. Table 1 Findings from laboratory and diagnostic assessments Test Parameters Patient’s value Normal Range Hemoglobin 15 g/dl 13–17 g/dl White blood cells 7200/ µL 4000–10000/ µL Platelets 250000/ µL 150000–450000/ µL Soduim 138mmol/L 135–145 mmol/L Potassium 4.5 mmol/L 3.5-5.0 mmol/L Urea 35 mg/dL 10–45 mg/dL Creatinine 0.9 mg/dL 0.6–1.3 mg/dL Glucose (Random Blood Glucose) 90 mg/dL 70–110 mg/dL AST 26U/L ALT 29 U/L Troponin I < 0.002 ng/mL < 0.04 ng/mL Total Biilirubin 0.8 mg/dL 0.3–1.2 mg/dL Direct Biilirubin 0.2 mg/dl 0-0.3 mg/dl Indirect Biilirubin 0.6 mg/dl 0.2-1.0 mg/dl Discussion Mad honey poisoning happens when honey contaminated with grayanotoxins is ingested, which are toxins present in the flowers and leaves of plants belonging to the Ericaceae family, including the genera Rhododendron, Pieris, and Agarista. Mad honey has historically been utilized in alternative medicine for ailments like hypertension, diabetes, and dyspepsia, though scientific proof backing these advantages is scarce. Moreover, its application as an aphrodisiac and for recreational activities is increasing [ 11 ]. Such behaviors heighten the likelihood of unintentional grayanotoxin poisoning, underscoring the necessity for healthcare professionals to be aware of the possible toxic consequences of honey consumption, particularly in areas where it is frequently eaten. [ 12 ]. Grayanotoxin I is regarded as the main toxic isomer that accounts for most clinical symptoms [ 13 ]. Grayanotoxins produce their toxic effects by attaching to voltage-gated sodium channels in neuronal and cardiac cells, hindering channel inactivation and resulting in extended depolarization. Animal research suggests that grayanotoxin primarily impacts the central nervous system, leading to bradycardia and respiratory depression. Moreover, the activation of the vagus nerve via M2 muscarinic receptors also aids in reducing the heart rate [ 14 , 15 ]. Mad honey toxicity results in bradycardia and sustained hypotension, primarily due to the suppression of central vasomotor centers. Activation of the unmyelinated afferent fibers of the vagus nerve lowers sympathetic output and diminishes peripheral vascular resistance. This mechanism results in cholinergic-like symptoms, typical of grayanotoxin poisoning [ 16 ]. Intoxication occurs after consuming approximately 15–30 g of mad honey, with symptoms manifesting around 2.8 ± 1.8 hours post-ingestion [ 17 , 18 ]. Conclusion Mad honey poisoning, though rare, can lead to abrupt bradycardia, hypotension, and gastrointestinal issues, especially in areas where wild or unrefined honey is regularly consumed. Due to the absence of a definitive laboratory test for grayanotoxin exposure, diagnosis primarily relies on a thorough dietary history and the identification of characteristic clinical signs. Supportive treatment, such as IV fluids and atropine for symptomatic bradycardia, is frequently beneficial, and the majority of patients make a full recovery. Clinicians need to recognize the potential for mad honey poisoning in patients with unexplained bradyarrhythmias and hypotension to facilitate prompt diagnosis and appropriate treatment. Abbreviations GCS: Glasgow coma scale ECG: Electrocardiogram Bpm – Beats per minute COPD - Chronic Obstructive Pulmonary Disease Declarations Acknowledgements We thank all the medical team and staffs involved in the treatment of this patient. Authors’ contributions N.P: Writing original draft, conceptualization, and literature review. M.P: Writing original draft, literature review and manuscript preparation. S.G: Conceptualization and Supervision. B.K: Clinical management and investigation. R.Y: Review and editing. All authors read and approved the final manuscript. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Data availability No datasets were generated or analyzed during the current study. Ethics approval and consent to participate As per the policy of our center, case reports not involving biomedical research are exempt from Institutional Review Committee (IRC) approval. Informed written consent has been obtained from the patient to participate. Consent for publication Informed written consent for publication of the patient’s case was obtained. Competing interests The authors declare no competing interests References Khan S. U., Anjum S. I., Rahman K., et al., “Honey: Single Foodstuff Comprises Many Drugs,” Saudi Journal of Biological Sciences 25, no. 2 (2018): 320–325. [DOI] [PMC free article] [PubMed] [Google Scholar] Sohn C. H., Seo D. 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Cite Share Download PDF Status: Published Journal Publication published 27 Mar, 2026 Read the published version in International Journal of Emergency Medicine → Version 1 posted Editorial decision: Revision requested 14 Dec, 2025 Reviews received at journal 02 Dec, 2025 Reviews received at journal 01 Dec, 2025 Reviews received at journal 27 Nov, 2025 Reviewers agreed at journal 27 Nov, 2025 Reviews received at journal 23 Nov, 2025 Reviewers agreed at journal 23 Nov, 2025 Reviewers agreed at journal 22 Nov, 2025 Reviewers agreed at journal 22 Nov, 2025 Reviewers invited by journal 22 Nov, 2025 Editor assigned by journal 17 Nov, 2025 Submission checks completed at journal 17 Nov, 2025 First submitted to journal 01 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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07:17:30\",\"extension\":\"jpeg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":399522,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eBaseline ECG at presentation showing sinus bradycardia (Heart rate 53 bpm) secondary to grayanotoxin ingestion.\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage1.jpeg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8005869/v1/a875340fc5fb53f4642a64ca.jpeg\"},{\"id\":96243941,\"identity\":\"3ebaf694-3190-4346-a13f-cb2df3289072\",\"added_by\":\"auto\",\"created_at\":\"2025-11-19 07:17:20\",\"extension\":\"jpeg\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":264083,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eECG revealing re-establishment of normal sinus rhythm after correction of bradycardia with Atropine.\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage2.jpeg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8005869/v1/a22fd5c49217cf5d0e0d739c.jpeg\"},{\"id\":105755765,\"identity\":\"e71bf9ca-1754-4054-92ff-029c9872e379\",\"added_by\":\"auto\",\"created_at\":\"2026-03-30 16:30:17\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1190617,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8005869/v1/390bc49c-e279-45b9-8f2a-da4055faa9c9.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"\\u003cp\\u003eMad Honey and the Heart: A Case Report of Transient Bradycardia and Hypotension from Nepal\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eRecent studies emphasize honey's role as a healing substance with notable antibacterial, antiviral, and antifungal effects. These impacts are mainly due to its acidic pH and enzymatic function, allowing honey to prevent the proliferation of microorganisms and aid in their elimination. [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eMad honey poisoning occurs due to ingesting honey tainted with grayanotoxin, a neurotoxin sourced from specific Rhododendron species in the hilly and Himalayan areas of Nepal. The world's largest honey bee species, the Himalayan giant honey bee (Apis laboriosa), can reach lengths of up to 3.0 cm. This species produces mad honey in the high-altitude areas of Nepal by gathering nectar from Rhododendron species that contain grayanotoxins [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eVarious areas globally, including Turkey, Japan, Nepal, North America, and Brazil, contain plants with significant amounts of grayanotoxins, potentially causing honey poisoning [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. The first recorded instances of extensive mad honey poisoning are traced to 401 BC, as detailed by the military leader Xenophon in his writings, Anabasis. Historically, mad honey has served as an aphrodisiac and a natural treatment for digestive issues like peptic ulcers, gastritis, and dyspepsia, along with intestinal disorders, arthritis, skin ailments, colds, and high blood pressure [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eBuratti et al. found that mad honey exhibits the highest antioxidant activity compared to other honey varieties. Mad honey is utilized as a weapon as well [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e].\\u003c/p\\u003e\"},{\"header\":\"Case presentation\",\"content\":\"\\u003cp\\u003eA 59-year-old male arrived at the emergency room with chief complaints of nausea, several instances of vomiting, and feelings of dizziness. He stated that these symptoms appeared suddenly around 60\\u0026ndash;80 minutes after he ingested 3\\u0026ndash;4 teaspoons (roughly 15\\u0026ndash;20 ml) of locally sourced \\\"mad honey\\u0026rdquo;. He refused any loss of awareness, convulsions, diarrhea, chest discomfort, or trouble breathing. During the presentation, he was attentive and completely aware of the time, location, and person. He had a known diagnosis of COPD for which he used one rota inhaler of Salmeterol and fluticasone and one rota inhaler of Tiotropium bromide daily. He had no documented history of heart disease and was not using any heart-related medications. There is no record of substance use, no unusual movement, shortness of breath, or chest discomfort. Upon examination, the patient looked uneasy and frail but stayed compliant. His blood pressure measured 60/40 mmHg, and his heart rate was 42 beats per minute. He was breathing easily at 17 breaths per minute, exhibiting a normal temperature and an oxygen saturation of 95% while on room air. Cardiovascular assessment showed significant bradycardia with no unusual heart sounds present. Auscultation showed clear lungs, the abdomen was non-tender and soft, and the neurological exam indicated no deficits. The diagnosis for this patient was primarily based on the distinct history of consuming mad honey, which was soon followed by symptoms including nausea, vomiting, dizziness, hypotension, and bradycardia. The short interval between eating and the emergence of symptoms strongly indicated grayanotoxin poisoning.\\u003c/p\\u003e\\u003cp\\u003eDue to the absence of a definitive laboratory test for mad honey intoxication, the diagnosis depended on thorough clinical assessment and ruling out other alternatives. We examined various differentials. Acute myocardial infarction was improbable since the patient experienced no chest pain, his cardiac enzymes were within normal limits, and the ECG displayed only sinus bradycardia without any ischemic alterations (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). Hypovolemia and sepsis were excluded due to the lack of fluid loss, fever, or infection indicators. A beta-blocker overdose was ruled out as the patient was not taking any such medication, and organophosphate poisoning was considered improbable due to the absence of cholinergic symptoms like excessive salivation, lacrimation, urination, diarrhea, gastrointestinal cramping, vomiting, miosis, bronchorrhea, or bronchospasm. Even though grayanotoxin levels in blood can be measured, there was no any laboratory facility in our hospital or in many hospitals across Nepal. Ultimately, the reliable history of honey consumption, the distinctive clinical presentation, and the thorough elimination of other potential causes resulted in the definitive diagnosis of mad honey (grayanotoxin) poisoning. The patient received immediate treatment with intravenous fluids and a one-time administration of 0.6 mg intravenous atropine. His heart rate and blood pressure progressively improved after treatment, and no further doses of atropine was required. His ECG after atropine is shown in Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e. He was monitored closely for 24 hours, during which his symptoms disappeared completely and his vital signs became stable. His blood investigations are given in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e. The patient was discharged the next day in stable condition and was advised to refrain from consuming wild or unprocessed honey again. He was requested to follow up after 2 weeks post-discharge. On follow up his basic blood tests and ECG results were normal.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eFindings from laboratory and diagnostic assessments\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"3\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTest Parameters\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003ePatient\\u0026rsquo;s value\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eNormal Range\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eHemoglobin\\u003c/p\\u003e \\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e15 g/dl\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e13\\u0026ndash;17 g/dl\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eWhite blood cells\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e7200/ \\u0026micro;L\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e4000\\u0026ndash;10000/ \\u0026micro;L\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePlatelets\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e250000/ \\u0026micro;L\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e150000\\u0026ndash;450000/ \\u0026micro;L\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSoduim\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e138mmol/L\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e135\\u0026ndash;145 mmol/L\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePotassium\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e4.5 mmol/L\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e3.5-5.0 mmol/L\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eUrea\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e35 mg/dL\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e10\\u0026ndash;45 mg/dL\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCreatinine\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.9 mg/dL\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.6\\u0026ndash;1.3 mg/dL\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eGlucose (Random Blood Glucose)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e90 mg/dL\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e70\\u0026ndash;110 mg/dL\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAST\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e26U/L\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eALT\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e29 U/L\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTroponin I\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.002 ng/mL\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.04 ng/mL\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTotal Biilirubin\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.8 mg/dL\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.3\\u0026ndash;1.2 mg/dL\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eDirect Biilirubin\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.2 mg/dl\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0-0.3 mg/dl\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eIndirect Biilirubin\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.6 mg/dl\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.2-1.0 mg/dl\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eMad honey poisoning happens when honey contaminated with grayanotoxins is ingested, which are toxins present in the flowers and leaves of plants belonging to the Ericaceae family, including the genera Rhododendron, Pieris, and Agarista.\\u003c/p\\u003e\\u003cp\\u003eMad honey has historically been utilized in alternative medicine for ailments like hypertension, diabetes, and dyspepsia, though scientific proof backing these advantages is scarce. Moreover, its application as an aphrodisiac and for recreational activities is increasing [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eSuch behaviors heighten the likelihood of unintentional grayanotoxin poisoning, underscoring the necessity for healthcare professionals to be aware of the possible toxic consequences of honey consumption, particularly in areas where it is frequently eaten. [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. Grayanotoxin I is regarded as the main toxic isomer that accounts for most clinical symptoms [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. Grayanotoxins produce their toxic effects by attaching to voltage-gated sodium channels in neuronal and cardiac cells, hindering channel inactivation and resulting in extended depolarization. Animal research suggests that grayanotoxin primarily impacts the central nervous system, leading to bradycardia and respiratory depression. Moreover, the activation of the vagus nerve via M2 muscarinic receptors also aids in reducing the heart rate [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eMad honey toxicity results in bradycardia and sustained hypotension, primarily due to the suppression of central vasomotor centers. Activation of the unmyelinated afferent fibers of the vagus nerve lowers sympathetic output and diminishes peripheral vascular resistance. This mechanism results in cholinergic-like symptoms, typical of grayanotoxin poisoning [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eIntoxication occurs after consuming approximately 15\\u0026ndash;30 g of mad honey, with symptoms manifesting around 2.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.8 hours post-ingestion [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e].\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eMad honey poisoning, though rare, can lead to abrupt bradycardia, hypotension, and gastrointestinal issues, especially in areas where wild or unrefined honey is regularly consumed. Due to the absence of a definitive laboratory test for grayanotoxin exposure, diagnosis primarily relies on a thorough dietary history and the identification of characteristic clinical signs. Supportive treatment, such as IV fluids and atropine for symptomatic bradycardia, is frequently beneficial, and the majority of patients make a full recovery. Clinicians need to recognize the potential for mad honey poisoning in patients with unexplained bradyarrhythmias and hypotension to facilitate prompt diagnosis and appropriate treatment.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eGCS:\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003eGlasgow coma scale\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eECG:\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003eElectrocardiogram\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eBpm\\u003c/strong\\u003e \\u0026ndash; Beats per minute\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCOPD\\u003c/strong\\u003e- Chronic Obstructive Pulmonary Disease\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe thank all the medical team and staffs involved in the treatment of this patient.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026rsquo; contributions\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eN.P: Writing original draft, conceptualization, and literature review. M.P: Writing original draft, literature review and manuscript preparation. S.G: Conceptualization and Supervision. B.K: Clinical management and investigation. R.Y: Review and editing. All authors read and approved the final manuscript.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData availability\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNo datasets were generated or analyzed during the current study.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAs per the policy of our center, case reports not involving biomedical research are exempt from Institutional Review Committee (IRC) approval. Informed written consent has been obtained from the patient to participate.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;Informed written consent for publication of the patient\\u0026rsquo;s case was obtained.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;The authors declare no competing interests\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n \\u003cli\\u003e\\u003ccite\\u003e\\u0026nbsp;Khan S. U., Anjum S. I., Rahman K., et al., \\u0026ldquo;Honey: Single Foodstuff Comprises Many Drugs,\\u0026rdquo; Saudi Journal of Biological Sciences 25, no. 2 (2018): 320\\u0026ndash;325.\\u0026nbsp;\\u003c/cite\\u003e[DOI] [PMC free article] [PubMed] [Google Scholar]\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003ccite\\u003eSohn C. H., Seo D. W., Ryoo S. 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Mavrofridis, Mad honey in medicine from antiquity to the present day, \\u003cem\\u003eArchives of Hellenic Medicine\\u003c/em\\u003e, 2013, \\u003cstrong\\u003e30\\u003c/strong\\u003e, 730\\u0026ndash;733 [84] https://www.mednet.gr/archives/2013-6/pdf/730.pdf\\u003c/li\\u003e\\n \\u003cli\\u003eBhumika N, Singh BZ (Retd). Six-legged soldiers: using insects as weapons of warfare. Med J Armed Forces India. 2011 Oct;67(4):325. doi: 10.1016/S0377-1237(16)30016-8. Epub 2016 May 30. PMCID: PMC4920639.\\u003c/li\\u003e\\n \\u003cli\\u003eTatli O. The Black sea\\u0026rsquo;s poison; Mad honey. J Anal Res Clin Med 2017; 5(1): 1-3. Doi: 10.15171/jarcm.2017.001\\u003c/li\\u003e\\n \\u003cli\\u003eS. Ullah, S.U. Khan, T.A. Saleh, S. Fahad Mad honey: uses, intoxicating/poisoning effects, diagnosis, and treatment RSC Adv., 8 (33) (2018), pp. 18635-18646, 10.1039/c8ra01924j View at publisher View in Scopus Google Scholar View in article\\u003c/li\\u003e\\n \\u003cli\\u003eAli H, Chiu C, Woltman N, Friedman MS, Harmouche E. Mad Honey Ingestion Leading to Grayanotoxin Poisoning During the Burning Man Music Festival: A Case Series. Cureus. 2024 Jun 20;16(6):e62755. doi: 10.7759/cureus.62755. PMID: 39036130; PMCID: PMC11259995.\\u003c/li\\u003e\\n \\u003cli\\u003eBaral S, Baral BK, Sharma P, Shrestha SL. Dried rhododendron flower ingestion presenting with bradycardia and hypotension: a case report. J Med Case Rep. 2022 May 13;16(1):189. doi: 10.1186/s13256-022-03413-8. PMID: 35551667; PMCID: PMC9101929.\\u003c/li\\u003e\\n \\u003cli\\u003eJansen SA, Kleerekooper I, Hofman ZL, Kappen IF, Stary-Weinzinger A, van der Heyden MA. Grayanotoxin poisoning: \\u0026apos;mad honey disease\\u0026apos; and beyond. Cardiovasc Toxicol. 2012 Sep;12(3):208-15. doi: 10.1007/s12012-012-9162-2. PMID: 22528814; PMCID: PMC3404272.\\u003c/li\\u003e\\n \\u003cli\\u003eOnat F, Yegen BC, Lawrence R, Oktay A, Oktay S. Site of action of grayanotoxins in mad honey in rats. J Appl Toxicol. 1991 Jun;11(3):199-201. doi: 10.1002/jat.2550110308. PMID: 1918794.\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003ccite\\u003eBilir O., Ersunan G., Yavasi O., Kayayurt K., Giakoup B., and Bostan M., \\u0026ldquo;How Much Should We Observe Patients With Mad Honey Poisoning?,\\u0026rdquo; Biomedical Research 28, no. 4 (2017): 1528\\u0026ndash;1532.\\u003c/cite\\u003e [Google Scholar]\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003ccite\\u003e\\u0026nbsp;Khan S. U., Anjum S. I., Rahman K., et al., \\u0026ldquo;Honey: Single Foodstuff Comprises Many Drugs,\\u0026rdquo; Saudi Journal of Biological Sciences 25, no. 2 (2018): 320\\u0026ndash;325.\\u0026nbsp;\\u003c/cite\\u003e[DOI] [PMC free article] [PubMed] [Google Scholar]\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003ccite\\u003eGunduz A., Meri\\u0026ccedil;\\u0026eacute; E. S., Baydın A., et al., \\u0026ldquo;Does Mad Honey Poisoning Require Hospital Admission?,\\u0026rdquo; American Journal of Emergency Medicine 27, no. 4 (2009): 424\\u0026ndash;427.\\u0026nbsp;\\u003c/cite\\u003e[DOI] [PubMed] [Google Scholar]\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":false,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":true,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"international-journal-of-emergency-medicine\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"ijem\",\"sideBox\":\"Learn more about [International Journal of Emergency Medicine](https://intjem.biomedcentral.com/)\",\"snPcode\":\"12245\",\"submissionUrl\":\"https://submission.nature.com/new-submission/12245/3\",\"title\":\"International Journal of Emergency Medicine\",\"twitterHandle\":\"@IntJEmergMed\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC/SO AJ\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Bradycardia, Case report, Grayanotoxin, Honey, Nepal, Rhododendron\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8005869/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8005869/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eConsuming 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.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCase presentation\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe 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.\\u003c/p\\u003e\\n\\u003cp\\u003eA 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.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAlthough 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.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Mad Honey and the Heart: A Case Report of Transient Bradycardia and Hypotension from Nepal\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-11-14 07:17:26\",\"doi\":\"10.21203/rs.3.rs-8005869/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2025-12-14T14:04:07+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-12-02T07:27:18+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-12-01T12:38:53+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-11-27T14:31:01+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"230794715184070238029480850361609065817\",\"date\":\"2025-11-27T13:24:35+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-11-23T17:49:51+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"261093107001529084326493753180313772079\",\"date\":\"2025-11-23T17:21:43+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"266170703441491026959726536199932409597\",\"date\":\"2025-11-22T15:33:31+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"278391852579815153343585646755007008051\",\"date\":\"2025-11-22T13:35:47+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-11-22T12:32:58+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-11-17T07:24:56+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-11-17T07:24:39+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"International Journal of Emergency Medicine\",\"date\":\"2025-11-01T13:06:34+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"international-journal-of-emergency-medicine\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"ijem\",\"sideBox\":\"Learn more about [International Journal of Emergency Medicine](https://intjem.biomedcentral.com/)\",\"snPcode\":\"12245\",\"submissionUrl\":\"https://submission.nature.com/new-submission/12245/3\",\"title\":\"International Journal of Emergency Medicine\",\"twitterHandle\":\"@IntJEmergMed\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC/SO AJ\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"ca781453-d652-4985-a681-2d778e2589cf\",\"owner\":[],\"postedDate\":\"November 14th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-03-30T16:24:58+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-8005869\",\"link\":\"https://doi.org/10.1186/s12245-026-01194-1\",\"journal\":{\"identity\":\"international-journal-of-emergency-medicine\",\"isVorOnly\":false,\"title\":\"International Journal of Emergency Medicine\"},\"publishedOn\":\"2026-03-27 16:09:21\",\"publishedOnDateReadable\":\"March 27th, 2026\"},\"versionCreatedAt\":\"2025-11-14 07:17:26\",\"video\":\"\",\"vorDoi\":\"10.1186/s12245-026-01194-1\",\"vorDoiUrl\":\"https://doi.org/10.1186/s12245-026-01194-1\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8005869\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8005869\",\"identity\":\"rs-8005869\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}