Mad Honey Sex: Therapeutic Misadventures From an Ancient Biological Weapon
Received 16 March 2009; received in revised form 24 April 2009; accepted 15 June 2009. published online 17 August 2009.
Study objective
“Mad honey” poisoning occurs from ingestion of honey produced from grayanotoxin-containing nectar, often in the setting of use as an alternative medicine. This study is designed to assess the clinical effects, demographics, and rationale behind self-induced mad honey poisoning.
Methods
The study consisted of 2 components: a standardized chart review of the signs, symptoms, and treatment of patients with mad honey ingestion, treated in our emergency department between December 2002 and January 2008; and a cross-sectional survey of a convenience sample of beekeepers specializing in the production and distribution of mad honey.
Results
We identified 21 cases. Patients were overwhelmingly men (18/21) and older (mean [SD]), 55 [11] years. Local beekeepers (N=10) ranked sexual performance enhancement as the most common reason for therapeutic mad honey consumption in men aged 41 through 60 years. Symptoms began 1.0 hour (SD 0.6 hour) after ingestion and included dizziness, nausea, vomiting, and syncope. Abnormal vital signs included hypotension (mean arterial pressure 58 mm Hg [SD 13 mm Hg]) and bradycardia (mean 45 beats/min [SD 9 beats/min]). Seventeen patients had sinus bradycardia and 2 had junctional rhythm. Nine patients were treated with atropine; 1 patient received dopamine. All patients were discharged 18 to 48 hours after admission.
Conclusion
A dietary and travel history should be included in the assessment of middle-aged men presenting with bradycardia and hypotension. A mad honey therapeutic misadventure may be the cause rather than a primary cardiac, neurologic, or metabolic disorder.
aDepartment of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
bDepartment of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
cEmergency Medicine, University of Michigan Health System, Ann Arbor, MI
Address for correspondence: Ahmet Demircan, MD, Gazi University School of Medicine, Department of Emergency Medicine, 06500 Besevler-Ankara-Turkey; +90 312 202 50 45, Fax +90 312 223 05 28
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.
Supervising editor: Richard C. Dart, MD, PhD.
Author contributions: AD, AK, and FB conceived the case series portion of the study. AD, GA, and NOD undertook data extraction of medical records. AD and HFG designed the survey portion of the investigation. AD and HFG drafted the article, and all authors contributed substantially to its revision. AD takes responsibility for the paper as a whole.
Reprints not available from the authors.
Publication date: Available online August 15, 2009.
ABSTRACT