Mad honey poisoning in Nepal: ecology, epidemiology, and clinical spectrum of grayanotoxin intoxication (2009-2026).

The bee forages on Rhododendron species whose nectar contains grayanotoxins, which become concentrated in the honey it produces.

Most cases originate in Gandaki Province, with Bagmati and Koshi Provinces increasingly represented.

Diagnosis remains entirely clinical, as grayanotoxin assay capacity is absent across all Nepali hospitals.