Limits...
Multi-organ dysfunction secondary to severe wasp envenomation.

Ittyachen AM, Abdulla S, Anwarsha RF, Kumar BS - Int J Emerg Med (2015)

Bottom Line: In spite of the heavy load of venom due to the multiple bites, the patient did not develop anaphylaxis.There was significant improvement by around 2 weeks; but it took another 6 months for the serum creatinine to normalize.This case highlights the occupational risk of Hymenoptera envenomation, the life-threatening complications that may follow and which may even be delayed as was the case with this patient, and the value of emergency care and intensive management which can result in a favorable clinical outcome.

View Article: PubMed Central - PubMed

Affiliation: Malankara Orthodox Syrian Church Medical College and Hospital, Ernakulam District, Kolenchery, Kerala State 682311 India.

ABSTRACT
Wasp sting is not an uncommon incident. Around 56% to 94% of the population is stung at least once in their lifetime by a member of the order Hymenoptera which includes wasps, bees, and ants. The response to a wasp sting may vary from mild local reaction to severe systemic and anaphylactic reactions. The clinical picture and mortality rate tend to be more severe in adults compared to children. We present a 32-year-old agricultural worker who was bitten by multiple wasps while on a coconut tree. In spite of the heavy load of venom due to the multiple bites, the patient did not develop anaphylaxis. However, a delayed reaction did occur within 48 h in the form of severe multi-organ dysfunction. There was significant improvement by around 2 weeks; but it took another 6 months for the serum creatinine to normalize. This case highlights the occupational risk of Hymenoptera envenomation, the life-threatening complications that may follow and which may even be delayed as was the case with this patient, and the value of emergency care and intensive management which can result in a favorable clinical outcome.

No MeSH data available.


Related in: MedlinePlus

Laboratory parameters. Note that all the parameters except creatinine had improved by about 2 weeks. It took another 6 months for the creatinine to normalize.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4385238&req=5

Fig3: Laboratory parameters. Note that all the parameters except creatinine had improved by about 2 weeks. It took another 6 months for the creatinine to normalize.

Mentions: Patient was managed initially in the intensive care unit (ICU). He received intravenous methylprednisolone and antihistamines (pheniramine maleate) for the first 24 h. He continued to be anuric for the first 14 days and in all received 12 sessions of hemodialysis till the urine output improved and uremic symptoms subsided. He was also transfused 6 units of fresh frozen plasma (FFP) and 4 units of platelet concentrate. The rest of the treatment included intravenous fluids, prophylactic antibiotics, oxygen, and symptomatic measures. By about 2 weeks, his laboratory parameters started improving (Figure 3). By the end of the third week, he was discharged successfully. Though urine output had been established, it took another 6 months for his serum creatinine value to normalize. Throughout his hospital stay, the patient was hemodynamically stable and also did not require any assisted ventilation.Figure 3


Multi-organ dysfunction secondary to severe wasp envenomation.

Ittyachen AM, Abdulla S, Anwarsha RF, Kumar BS - Int J Emerg Med (2015)

Laboratory parameters. Note that all the parameters except creatinine had improved by about 2 weeks. It took another 6 months for the creatinine to normalize.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4385238&req=5

Fig3: Laboratory parameters. Note that all the parameters except creatinine had improved by about 2 weeks. It took another 6 months for the creatinine to normalize.
Mentions: Patient was managed initially in the intensive care unit (ICU). He received intravenous methylprednisolone and antihistamines (pheniramine maleate) for the first 24 h. He continued to be anuric for the first 14 days and in all received 12 sessions of hemodialysis till the urine output improved and uremic symptoms subsided. He was also transfused 6 units of fresh frozen plasma (FFP) and 4 units of platelet concentrate. The rest of the treatment included intravenous fluids, prophylactic antibiotics, oxygen, and symptomatic measures. By about 2 weeks, his laboratory parameters started improving (Figure 3). By the end of the third week, he was discharged successfully. Though urine output had been established, it took another 6 months for his serum creatinine value to normalize. Throughout his hospital stay, the patient was hemodynamically stable and also did not require any assisted ventilation.Figure 3

Bottom Line: In spite of the heavy load of venom due to the multiple bites, the patient did not develop anaphylaxis.There was significant improvement by around 2 weeks; but it took another 6 months for the serum creatinine to normalize.This case highlights the occupational risk of Hymenoptera envenomation, the life-threatening complications that may follow and which may even be delayed as was the case with this patient, and the value of emergency care and intensive management which can result in a favorable clinical outcome.

View Article: PubMed Central - PubMed

Affiliation: Malankara Orthodox Syrian Church Medical College and Hospital, Ernakulam District, Kolenchery, Kerala State 682311 India.

ABSTRACT
Wasp sting is not an uncommon incident. Around 56% to 94% of the population is stung at least once in their lifetime by a member of the order Hymenoptera which includes wasps, bees, and ants. The response to a wasp sting may vary from mild local reaction to severe systemic and anaphylactic reactions. The clinical picture and mortality rate tend to be more severe in adults compared to children. We present a 32-year-old agricultural worker who was bitten by multiple wasps while on a coconut tree. In spite of the heavy load of venom due to the multiple bites, the patient did not develop anaphylaxis. However, a delayed reaction did occur within 48 h in the form of severe multi-organ dysfunction. There was significant improvement by around 2 weeks; but it took another 6 months for the serum creatinine to normalize. This case highlights the occupational risk of Hymenoptera envenomation, the life-threatening complications that may follow and which may even be delayed as was the case with this patient, and the value of emergency care and intensive management which can result in a favorable clinical outcome.

No MeSH data available.


Related in: MedlinePlus