What is the culprit toxin causing the effects seen from ingestion of “mad honey”?
Grayanotoxin. Honey produced from Rhododendrons (Ericaceae family) is known to contain grayanotoxins, the main isomer being grayanotoxin III. These neurotoxins block sodium channels, thereby interfering with the action potential in cell membranes, which produce the effects seen in the central nervous system, skeletal muscle, cardiac cells.
Submitted by: Abigail Sharpe, PharmD and Ryan Feldman, PharmD, DABAT on behalf of the Acute and Intensive Care Section