Clinical characteristics and outcomes of patients with wild honey poisoning: a five-year retrospective study from Nepal

Wild honey poisoning caused by grayanotoxin-containing honey is an important toxicological emergency in the hilly and Himalayan regions of Nepal, where traditional consumption of wild honey remains common. However, systematic hospital-based data on its clinical presentation and outcomes remain limited. We conducted a retrospective observational study of all eligible patients presenting with wild honey poisoning to a tertiary care hospital in eastern Nepal between January 2019 and January 2024. Demographic, clinical, management, and outcome data were extracted from medical records. Thirty-one patients were included, with a median age of 51 years (IQR, 37–58.5); 71% were male. Neurological manifestations were the most common presentation (87.1%), particularly dizziness/light-headedness (64.5%), altered sensorium (48.4%), and loss of consciousness (38.7%). The median estimated honey ingestion was 30 mL (IQR, 17.5–30), and the median time to symptom onset was 45 min (IQR, 30–60). Bradycardia (74.2%) and hypotension (58.1%) were common at presentation, with median pulse rate and blood pressure of 48 beats/min and 90/50 mmHg, respectively. Most patients received intravenous fluids (93.5%), and 58.1% received atropine. The mean hospital stay was 1.48 ± 0.85 days. Most patients recovered and were discharged (93.5%), 6.5% left against medical advice, and no deaths occurred. Wild honey poisoning commonly presents with neurological symptoms accompanied by characteristic cardiovascular manifestations, particularly bradycardia and hypotension. Early recognition and supportive management are associated with favorable outcomes.