Emergency Response: Recognising and Responding to Mad Honey Adverse Effects

Contents

1. Recognising Mad Honey Adverse Effects
2. What to Do: Step by Step
3. How Mad Honey Intoxication Is Treated Clinically
4. Information to Give at the Hospital
5. Sources

Recognising Mad Honey Adverse Effects

Onset Timing

Most adverse effects from mad honey begin within 30 minutes to 3 hours of consumption. Onset as fast as 20 minutes has been documented in published cases. If symptoms appear outside this window, they may still be related to mad honey, but alternative causes should also be considered by a clinician.

Mild Symptoms: Most Frequently Reported

• Dizziness or lightheadedness (most common early symptom)
• Nausea and/or vomiting
• Excessive sweating (diaphoresis)
• Tingling or numbness, especially around lips or fingertips (paraesthesia)
• Blurred or double vision
• Weakness in limbs
• Hypersalivation

Moderate Symptoms: Cardiovascular Involvement

• Slowed heart rate: feels like heartbeats are further apart than normal
• Feeling faint or actually fainting (syncope)
• Low blood pressure: may present as an inability to stand without dizziness
• Chest discomfort (not sharp pain, more a sense of heaviness or pressure)
• Pallor and cold sweating together (signs of haemodynamic compromise)

Severe Symptoms: Call Emergency Services Immediately

• Loss of consciousness that does not rapidly resolve
• Very slow pulse: below approximately 40 beats per minute
• Cannot wake or rouse the person
• Laboured breathing
• Prolonged inability to stand or walk (more than a few minutes)
• Chest pain with slow pulse

What to Do: Step by Step

Step 1: Assess the Situation

Ask: Is the person conscious and responding normally? Can they stand without fainting or extreme dizziness? Is their heart rate measurable?

If NO to any of these, call emergency services immediately. If YES to all, call Poison Control and continue to Step 2.

Step 2: Call Poison Control

• US: 1-800-222-1222
• UK: 0344 892 0111
• Australia: 13 11 26
• Canada: 1-800-268-9017

Have this information ready: what was consumed (mad honey, brand/vendor name if known); approximate quantity consumed; when it was consumed; current symptoms; person’s age, weight, and any medical conditions; any medications they are taking.

Step 3: Monitor and Position

While waiting for advice from Poison Control or emergency services:

• Have the person sit or lie down. Do not let them stand unsupported.
• If lying down, position on their side (recovery position) in case of vomiting. This reduces aspiration risk.
• Keep them awake and talking if conscious.
• Monitor pulse rate if possible. Count beats for 15 seconds, multiply by 4. Record the time and rate. This information is valuable for treating clinicians.
• Keep them warm.

What NOT to do: Do not induce vomiting. Do not give any additional medications, including over-the-counter remedies. Do not give food or drink other than sips of water if they are fully alert. Do not leave them alone.

Step 4: Emergency Services, When Needed

Call 911 (US), 999 (UK), or 112 (Europe) if any of the following apply:

• Loss of consciousness that does not rapidly resolve
• Pulse below approximately 40 bpm or absent
• Fainting more than once
• Symptoms are rapidly worsening rather than stable
• Chest pain with slow pulse

 

Tell the dispatcher and arriving paramedics exactly what was consumed. Grayanotoxin intoxication can mimic cardiac arrhythmia, myocardial infarction, or organophosphate poisoning if the consumption history is unknown.

How Mad Honey Intoxication Is Treated Clinically

The following describes what published clinical guidelines and case series report about treatment. This is provided for informational context, not as a guide to self-treatment.

Monitoring

Admitted patients are placed on continuous cardiac monitoring (ECG). Bradycardia and hypotension are tracked. Most published Turkish case series report monitoring durations of 12–24 hours before discharge in uncomplicated cases.

Atropine for Bradycardia

Atropine, an anticholinergic drug that increases heart rate by blocking parasympathetic vagal tone, is the most commonly used first-line treatment in published case reports. Typical doses in case series: 0.5–1 mg IV, repeated as needed. Response is generally rapid. Published cases report heart rate normalisation within minutes to hours of atropine administration in the majority of cases.

Intravenous Fluids for Hypotension

IV crystalloid fluids (normal saline or Ringer’s lactate) are administered to support blood pressure. Volume expansion helps compensate for the vasodilation component of GTX-induced hypotension.

Temporary Pacing (Rare)

In the most severe published cases, involving complete AV block that did not respond adequately to atropine, temporary transvenous or transcutaneous cardiac pacing has been used. These represent a minority of published cases.

No Antidote

There is no specific antidote to grayanotoxin. Treatment is entirely supportive, aimed at managing cardiovascular effects while GTX is eliminated. The generally good prognosis reflects the reversible nature of GTX’s sodium channel binding, once GTX is cleared from circulation, the channels function normally.

Information to Give at the Hospital

Sources

1. Jansen SA, et al. (2012). Grayanotoxin poisoning: ‘mad honey disease’ and beyond. Cardiovascular Toxicology, 12(3), 208–215.  https://pmc.ncbi.nlm.nih.gov/articles/PMC3404272/
2. Demir H, Denizbasi A, Onur O. (2011). Mad honey intoxication: a case series of 21 patients. ISRN Toxicology.  https://pmc.ncbi.nlm.nih.gov/articles/PMC3658790/
3. Eroğlu SE, Urgan O, Onur OE, et al. (2013). Grayanotoxin (mad honey): ongoing consumption after poisoning. Balkan Medical Journal. https://pmc.ncbi.nlm.nih.gov/articles/PMC4115918/
4. Aygun A, Sahin A, Karaca Y, et al. (2018). Grayanotoxin levels in blood, urine and honey and their association with clinical status in patients with mad honey intoxication. Turkish Journal of Emergency Medicine, 18(1), 29–33.  https://www.sciencedirect.com/science/article/pii/S2452247317300584
5. Aryal M. (2025). Grayanotoxins in mad honey: mechanisms of toxicity, clinical management, and therapeutic implications. Journal of Applied Toxicology, 45(11), 2240–2256.  https://doi.org/10.1002/jat.4855

 

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