Case Presentation
A 45-year-old male was brought to the emergency department (ER) due to
dizziness followed by loss of consciousness for 20 minutes. He also had
multiple episodes of vomiting and excessive sweating. As per the
patient, he had consumed nearly 100 ml of wild honey twenty minutes
prior to the onset of symptoms. He had a laceration under his chin due
to the fall which was actively bleeding. He was diabetic and
hypertensive and was taking Metformin 500 mg twice daily and Losartan 25
mg once daily.
On examination, the patient was conscious and oriented but agitated. His
blood pressure was 70/50 mm Hg, pulse rate was 58 beats/minute and
regular, respiratory rate was 24 breaths/min, and oxygen saturation was
98%. There were no additional sounds during auscultation. A 12-lead ECG
was obtained (Figure 1) promptly which showed sinus bradycardia with
prolonged QT interval (481 ms) with non-specific ST-segment changes.
Cardiac biomarkers however were negative. A random blood glucose
assessment at the ER revealed blood glucose of 448mg/dL. He received 6
units of subcutaneous regular insulin stat at the ER. Blood glucose was
monitored hourly. Routine blood investigations were sent which are given
in Table 1.
Based on the history and presentation, diagnosis of wild honey poisoning
was made. Treatment was immediately started with intravenous (IV) normal
saline, IV hydrocortisone 100 mg (stat and three times a day), and IV
atropine (SOS, if heart rate <40 beats/min). Laceration was
repaired. After 2 hours at the ER, his vitals stabilized (BP: 110/80mm
Hg, pulse 70/min). Thereafter, he was shifted to ICU for observation.
His blood pressure dropped again after few hours of shifting to ICU (BP:
85/65mm hg). As a result, he was started on vasopressor support with
nor-adrenaline at 2.5 ml/hr. His blood pressure stabilized within the
next hour and the infusion was stopped altogether. The patient’s vitals
were stable overnight. Hyperglycemia was managed with infusion of
regular insulin. He was shifted to the ward the next day and discharged
the day after.