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.