Mad honey mimicking acute coronary syndrome

A 56-year-old Nepalese man presented to the hospital with syncope, bradycardia, and hypotension. Throughout his admission, he was hemodynamically unstable, with associated electrocardiographic changes and fluctuations in consciousness. This followed the unintentional overdose of the traditional medicine “mad honey” containing grayanotoxins with hallucinogenic properties. Following treatment with an anticholinergic infusion, he made a full recovery within 48 hours. This case underlines the importance of considering atypical causes for presentations such as bradycardia and hypotension, especially in patients from cultures where mad honey usage is common, and highlights the potential adverse events of this traditional medicine to be life-threatening.