Acute life-threatening bradycardia due to poisoning with Turkish wild honey

History and findings: A 49-year-old Turkish man, previously well, suddenly developed severe vertigo and a feeling of retrosternal compression. The symptoms had set in within one hour of eating Turkish wild honey. The patient was in a poor general state with a heart rate of 38/min after administration of atropine by the general practitioner who had been called. Arterial blood pressure was 90/45 mm Hg. Investigation: All routine biochemical tests were normal. The electrocardiogram merely showed sinus bradycardia of 38 beats/min. Treatment and course: Under purely symptomatic treatment the heart rate and blood pressure returned to normal within 24 hours. The history of eating wild honey and typical symptoms indicated acetylandromedol poisoning. Conclusion: Turkish honey from the Black Sea coast occasionally contains concentrations of acetylandromedol (formerly called andromedotoxin) high enough to cause poisoning. The substance is obtained by bees from some species of Rhododendron which they then incorporate into their honey. Typical of the poisoning are gastrointestinal symptoms and marked, even life-threatening, bradycardia and arterial hypotension.