Wild honey (grayanotoxin) intoxication and its complex interaction with pre-existing co-morbidities, influencing presentation and outcome: a case series

Abstract

Background Grayanotoxin-containing wild honey causes cholinomimetic activity through voltage-gated sodium channel activation and increases the excitability of cardiac and neuronal membranes, leading to cardiovascular and neuronal toxicity. Prior studies describe general-population cases, but interactions with co-morbidities are unexplored.Methods A retrospective case series (2019–2024) of 10 patients with confirmed ingestion and preexisting co-morbidities (diabetes mellitus, hypertension, dyslipidemia, and ischemic heart disease) presenting to Manipal Teaching Hospital, Nepal. Hospital medical records and telephone-based questionnaire were used to collect demographics, ingestion history, symptoms, vital signs, investigation results, management, and outcomes.Findings Mean age was 56.4 years with co-morbidity in all. Predominant cardiovascular and neurological symptoms with dizziness (90%), vomiting (30%), and seizures (30%). Major cardiovascular features were bradycardia (80%) and hypotension (60%); T-wave inversions (V5–V6) exclusively in all IHD patients (2/2 seizure with normal cardiac biomarker). All diabetics (2/2)presented in hyperglycemic state (>200 mg/dL) and developed acute renal impairment (creatinine 1.5–1.6 mg/dL) during hospital stay; non-diabetics (3/8) presented in hypoglycemic state (<70 mg/dL). Supportive care yielded full recovery without mortality (median stay 2.7 days) or sequelae.Conclusion Grayanotoxin amplifies the severity of co-morbid conditions with distinct patterns: diabetes leading to hyperglycemia and renal impairment; T wave changes with seizure in ischemic heart disease, prompting enhanced and intensive monitoring requirements in patients with co-morbid condition.