Acute Renal Failure Following Bee Sting

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Bees are known stinging insects belonging to order hymenoptera.
They are found mostly in tropical countries.
Honey produced by them are used as medicines in different diseases.
However, their sting can be dangerous.
Isolated sting by these insects just causes allergic reactions.
Multiple stings to single individual by swarm of these insects even cause death.
It is due to the injection of large dose of venom which causes systemic symptoms.
Following about 700-800 bee stings, rhabdomyolysis and hemolysis with consequent acute renal failure developed.
Sting of bee has a stylus with two barbed lancets on either side.
The bee itself does not push stylus but its drawn in by barbed slide.
Amount of venom each sting is 5-50 micro gm of fluid.
Farmers, hive workers, young children are usually affected.
Common initial symptoms include anorexia, nausea, vomiting, decreased urine output, swelling, pruritis, decreased blood pressure leading to death.
Decrease urine output was found in 100% cases, swelling in 40% and generalized body ache in 60% cases.
Local reactions to isolated sting cause swelling around site which resolves without specific treatment.
It depends on whether the sting is isolated or multiple.
Toxic reactions to multiple stings may mimic anaphylactic reactions.
These reactions are due to the production of immunoglobulin E(IgE) antibodies, histamine and inflammatory mediators, in response to injected venom.
It takes only few minutes to hours to develop in patients who are allergic to sting venom.
Precipitins produced as delayed response, causes bruises, blisters and even tissue damage.
Medical disorders such as encephalitis, polyneuritis, rarely follow bee stings.
The outcome of bee stings depends upon site of sting.
Stinging at vocal cords may occur after swallowing bees which results in breathing difficulty which is usually fatal.
In multiple stings, amount of injected venom is so high that patient becomes nephrotoxic.
It is due to ischemia and acute tubular necrosis, patient may develop acute renal failure and eventually death occurs.
Serum sickness may appear following multiple stings.
So bee stings should never be neglected.
First aid measure is removal of sting itself.
Even a slight delay in its removal results in injection of venom into the body.
Traditional remedies include use of baking soda, toothpaste, garlic, silver coins etc.
Medical management is with antigen specific immunotherapy.
This reduces allergy in 50% cases.
In known allergic patients epinephrine injection can be used as immediate measure for preventing anaphylactic reactions.
Dehydration is corrected depending upon condition of patient and haemodialysis can also be carried out if necessary.
Prognosis is better in people having only one or few stings, with local allergic reactions.
Follow up care is required in patients with systemic symptoms and complications.
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