A New Risk Factor for Hepatic Encephalopathy: Ingestion of Mad Honey

Öz

Hepatic encephalopathy (HE) is a neuropsychiatric syndrome that occurs in the severe liver dysfunction and is characterized by a wide range of central nervous system symptoms. HE precipitated with mostly infections, gastrointestinal bleeding, diuretic overdose, electrolyte imbalance, constipation and drugs. Traditional local foods for example honey can contain toxins for the liver and could cause acute decompensation in patients with chronic liver disease (CLD). This toxins can cause dose related severe symptoms. Spectrum of the symptoms are from nausea vomiting to life threatening bradycardia and/or hypotension. In this paper; we reported first time in English literature a cirrhotic case with HE due to consumption of mad honey.

Anahtar Kelimeler

• Grayanotoxins (GTS)
• hepatic encephalopathy (HE)
• mad honey (MH)

Kaynakça

1. Reference1: Wijdicks EF. Hepatic Encephalopathy. N Engl J Med. 2016 Oct 27;375(17):1660-1670.
2. Reference2: Weissenborn K. Hepatic Encephalopathy: Definition, Clinical Grading and Diagnostic Principles. Drugs. 2019 Feb;79(Suppl 1):5-9.
3. Reference3: Huseyin Sahin, Emine Akyuz Turumtay, Oktay Yildiz & Sevgi Kolayli Grayanotoxin-III Detection and Antioxidant Activity of Mad Honey, International Journal of Food Properties. 2015 18:12, 2665-2674, DOI: 10.1080/10942912.2014.999866.
4. Reference4: M. Bostan, H. Bostan, A. O. Kaya et al. Clinical events in mad honey poisoning: a single centre experience. Bulletin of Environmental Contamination and Toxicology, vol. 84, no. 1, pp. 19–22, 2010.
5. Reference5: Cestèle S, Catterall WA. Molecular mechanisms of neurotoxin action on voltage-gated sodium channels. Biochimie. 2000 Sep-Oct;82(9-10):883-92. doi: 10.1016/s0300-9084(00)01174-3. PMID: 11086218.
6. Reference6: Onat FY, Yegen BC, Lawrence R, Oktay A, Oktay S. Mad honey poisoning in man and rat. Rev Environ Health. 1991;9(1):3-9. doi: 10.1515/reveh. 1991.9.1.3. PMID: 1957047.
7. Reference7: Silici S, Atayoglu AT. Mad honey intoxication: A systematic review on the 1199 cases. Food Chem Toxicol. 2015 Dec;86:282-90. doi: 10.1016/j.fct.2015.10.018. Epub 2015 Nov 10. PMID: 26547022. pp. 595–598, 2006.
8. Reference8: Koca I, Koca AF. Poisoning by mad honey: a brief review. Food Chem Toxicol. 2007 Aug;45(8):1315-8. doi: 10.1016/j.fct.2007.04.006. Epub 2007 Apr 21. PMID: 17540490.

9. Reference9: Poon WT, Ho CH, Yip KL, Lai CK, Cheung KL, Sung RY, et al. Grayanotoxin poisoning from Rhododendron simsii in an infant. Hong Kong Med J. 2008;14(5):405–407.
10. Reference10: Dilber E, Kalyoncu M, Yarıs¸ N, Ökten A. A case of mad honey poisoning presenting with convulsion: intoxication instead of alternative therapy. Turk J Med Sci 2002;32:361–362X.
11. Reference11: Kuru P, Torun M, Halac HM, Temiz G, Iskender E, Karamahmutoglu T, et al. Electroencephalographic and behavioral effects of intracerebroventricular or intraperitoneal injections of toxic honey extract in adult Wistar rats and GAERS. Neurol Sci. 2014 Dec;35(12):1903-8. doi: 10.1007/s10072-014-1858-6. Epub 2014 Aug 14. PMID: 25120202.
12. Reference12: Doğanyiğit Z, Silici S, Demirtaş A, Kaya E, Kaymak E. Determination of histological, immunohistochemical and biochemical effects of acute and chronic grayanotoxin III administration in different doses in rats. Environ Sci Pollut Res Int. 2019 Jan;26(2):1323-1335. doi: 10.1007/s11356-018-3700-9. Epub 2018 Nov 13. PMID: 30426365.
13. Reference13: Gunduz, S. Turedi, H. Uzun, and M. Topbas. Mad honey poisoning. American Journal of Emergency Medicine, vol. 24, no. 5.
14. Reference14: Disney AA, Aoki C. Muscarinic acetylcholine receptors in macaque V1 are most frequently expressed by parvalbumin-immunoreactive neurons. J Comp Neurol 2008;507:1748–1762.
15. Reference15: Olga A. Sergeeva, GABAergic transmission in hepatic encephalopathy, Archives of Biochemistry and Biophysics, Volume 536, Issue 2, 2013, Pages 122-130, ISSN 0003-9861,https://doi.org/10.1016/j.abb.2013.04.005.