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Delayed toxic reaction following massive bee envenomation
1Good Samaritan Regional Poison Center, Good Samaritan Regional Medical Center, Phoenix, AZ, USA.
Annals of Emergency Medicine
|December 29, 1998
Summary
Massive bee stings can cause delayed toxic reactions, even in asymptomatic patients. Extended observation and hospitalization are recommended for high-risk individuals to monitor for serious complications like organ failure.
Area of Science:
- Toxicology
- Emergency Medicine
- Clinical Case Study
Background:
- Massive bee envenomation presents immediate and delayed toxic reactions.
- Immediate reactions include fatigue, nausea, vomiting, hemolysis, kidney failure, and disseminated intravascular coagulation (DIC).
Observation:
- A 66-year-old man experienced over 125 Africanized bee stings.
- Initially asymptomatic with normal labs, he developed fatal multi-organ system failure 18 hours post-envenomation.
- Delayed toxic reactions can manifest with hemolysis, coagulopathy, thrombocytopenia, rhabdomyolysis, liver, and kidney dysfunction.
Findings:
- Delayed toxic reactions are a significant risk after massive bee envenomation.
- Patients asymptomatic or with pain only may develop severe delayed complications.
- Early identification and intervention are crucial for managing delayed envenomation effects.
Implications:
- Recommend 24-hour hospitalization for pediatric, elderly, or medically compromised patients with ≥50 stings.
- Suggest 6-hour emergency department observation for other asymptomatic or pain-only patients.
- Prompt initiation of intensive medical measures is vital for severe envenomation cases.