Examination using LC-MS/MS determination of grayanotoxin levels in blood, urine, and honey consumed by patients presenting to the emergency department with mad honey intoxication and relations with clinical data: a preliminary study.
OBJECTIVE
Intoxications related to "mad honey" are frequently encountered in the Black Sea region of Turkey. Intoxication is established on the basis of whether honey was consumed when history was taken at presentation. The search for a simple and reliable method for showing the grayanotoxins (GTXs) in mad honey in body fluids and in honey consumed by patients is still at the research stage. The purpose of this preliminary study was to investigate GTX levels in blood, urine, and honey consumed by patients with mad honey intoxication and to determine whether there is an association with clinical status.


METHODS
This descrptive study was conducted at the department of Emergency Medicine of Karadeniz Technical University Medical Faculty in Turkey. Mad honey, blood, and urine samples were obtained from patients between September 2013 and October 2014.


METHODS
Four cases presenting the Department of Emergency Medicine and diagnosed with mad honey intoxication were included in the study. GTX levels in blood, urine, and honey consumed by patients were determined using liquid chromatography-tandem mass spectrometry.


RESULTS
Patients' mean blood GTX I level was 30.62 ng/mL, GTX III level 4.917 ng/mL, urine GTX I level 0.447 mg/mL, and GTX III level 1.998 mg/mL. The mean GTX I level in the honey samples consumed was 4.683 mg/g and GTX III level 8.423 mg/g.


CONCLUSIONS
The present study is unique in representing the first time that GTXs have been determined in human body fluids. There is now an urgent need for a large series of studies to provide statistical evidence whether there is a relationship between levels of toxins in human body fluids and clinical picture.
Dr. Ali Aygun, Department of Emergency Medicine,, Faculty of Medicine,, Karadeniz Technical University,, Trabzon 61080, Turkey, T :+90. 04623775204, F:+90. 04623775444, dr_aliaygun@hotmail.com.
Ali
A
Aygun
Abdulkadir
A
Gunduz
Suleyman
S
Turedi
Suha
S
Turkmen
Yunus
Y
Karaca
Faik Ahmet
FA
Ayaz
Su Youn
SY
Ahn
Suncheun
S
Kim
D000328:Adult; D000368:Aged; D002853:Chromatography, Liquid / Q000379:methods; D004224:Diterpenes / Q000032:analysis / Q000506:poisoning*; D004636:Emergency Service, Hospital; D005260:Female; D006722:Honey / Q000506:poisoning*; D006801:Humans; D008297:Male; D008875:Middle Aged; D053719:Tandem Mass Spectrometry / Q000379:methods; D014421:Turkey
D004224:Diterpenes; C001311:grayanotoxin I; C020751:grayanotoxin III