Grayanotoxin levels in blood, urine and honey and their association with clinical status in patients with mad honey intoxication

Ali Aygun; Aynur Sahin; Yunus Karaca; Suha Turkmen; Suleyman Turedi; Su Youn Ahn; Suncheun Kim; Abdulkadir Gunduz

doi:10.1016/j.tjem.2017.05.001

Ali Aygun¹, Aynur Sahin², Yunus Karaca², Suha Turkmen³, Suleyman Turedi², Su Youn Ahn⁴, Suncheun Kim⁴, Abdulkadir Gunduz²

¹Department of Emergency Medicine, Ordu University Education and Research Hospital, Ordu, Turkey
²Department of Emergency Medicine, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
³Department of Emergency Medicine, Acıbadem University, Faculty of Medicine, Istanbul, Turkey
⁴Department of Forensic Toxicology, National Forensic Service, Daejeon Institute, Daejeon, Republic of Korea

Keywords: Mad honey, Grayanotoxin, LC-MS/MS, Blood, Urine, Pulse, Blood pressure

Abstract

Objectives: The purpose of this study was to investigate whether there is an association between grayanotoxin levels in urine and blood of patients with mad honey intoxication and in the honey consumed, and the resulting clinical picture. The pilot data acquired from this study was analysed in National Forensic Service, Daejeon Institute, South Korea and first results were published as a preliminary study.

Patients and methods: This descriptive study was conducted at a university hospital emergency department in Turkey. 25 cases diagnosed with mad honey intoxication were obtained the study. Samples of mad honey consumed by patients were obtained. Blood and urine specimens were collected at presentation to the emergency department. GTX 1 and GTX 3 levels from patients' blood, urine and honey consumed were investigated simultaneously using the LC-MS/MS system.

Results: Mean GTX 1 concentration in blood was 4.82 ng/mL and mean GTX 3 level 6.56 ng/mL. Mean GTX concentration in urine was 0.036 μg/mL and mean GTX 3 level 0.391 μg/mL. Mean GTX I concentration in honeys consumed was 8.73 μg/gr and mean GTX 3 level 27.60 μg/gr.

Conclusion: This descriptive study is show grayanotoxin levels in body fluids of patients with mad honey intoxication. No association was determined between grayanotoxin levels in blood and clinical data.