Bee stings: diagnosis and treatment of active resuscitation

2021-07-29 12:39 AM

The venom component consists of the venom sac located in the posterior abdomen of the female. The severity depends on the type of bee, the number of nodules.

Take out the stinger, treat local reactions,watch closely for signs of anaphylaxis

Take out the stinger, treat local reactions, watch closely for signs of anaphylaxis

Bees belong to the order of two main families:

The wasp family includes wasps and yellow wasps.

The honey bee family includes honey bees and gourds.

The venomous part consists of the venom sac and stinger located in the rear abdomen of the female.

Bee venom has about 40 components including enzymes such as phospholipase, hyaluronidase, cholinesterase, peptide, melittin, apamin, and biologically active amines.

The severity depends on the type of bee, the number of stings, and the location of the sting.

Early and aggressive management focuses on fluid administration, enhancement of diuresis, and determination of the outcome of toxicity.

Definite diagnosis

Clinical symptoms

In place:

Manifestations: skin redness, pain, itching, edema, a few centimeters in diameter around the burn.

Sharp pain after a few minutes turns into a burning pain, itchy papules, urticaria, and a burning sensation within a few hours of burning.

The middle of the bee sting is white necrotic, surrounded by red borders, edema, lesions on the skin that persist for a few days to a few weeks.

If there are many nodules, it can cause edema of the entire limb or trunk.

Burned into the oropharynx causes edema, constriction of the larynx, causing difficulty breathing.

Burning to the periorbital area or eyelids can cause cataracts, iritis, vitreous abscess, eyeball perforation, glaucoma, and refractive disorders.

Local symptoms are most severe 48-72 hours after a bee sting and last for weeks.

Bee venom directly into the blood vessels is also dangerous.

Systemic symptoms:

Symptoms of bee venom poisoning occur when there are many strings (10 or more spots). If > 50 nodules, systemic symptoms may manifest immediately (very difficult to distinguish from anaphylaxis) or after several days. Includes widespread edema, burning sensation, sweating, conjunctivitis, headache, nausea, vomiting, abdominal pain, muscle weakness, fatigue, dizziness.

Manifestations: vomiting, diarrhea, shock, coma, hemolysis and hemoglobinuria, rhabdomyolysis appearing after 24-48 hours, acute renal failure, thrombocytopenia.

Myocardial infarction and hepatocellular necrosis were seen in fatal patients.

There may be hemolysis, bleeding in many places. Note bleeding in the lungs or brain. There may be disseminated intravascular coagulopathy.

Coma and convulsions.

Symptoms of bee venom incubation usually occur after a few minutes to a few hours after being stung by a bee, and death usually occurs within the first hour.

Skin: generalized redness, angioedema, urticaria, pruritus.

Respiratory: bronchospasm, stridor, increased bronchial secretions, laryngeal edema, tongue edema, and upper respiratory tract edema causing hypoxia. Constriction and swelling of the glottis cause difficulty breathing in the larynx.

Cardiovascular: tachycardia, hypotension, syncope, ECG changes ST and T.

Gastrointestinal: vomiting, nausea, diarrhea, abdominal cramps, bloating.

Tests to assess severity and monitor progress

Blood test

Biochemistry: urea, creatinine, electrolytes, glucose, CK increased, CKMB, AST increased, ALT increased, bilirubin. serum iron, hemolytic bilan test.

Urinalysis, myoglobinuria.

Basic coagulation. When there is liver damage and coagulation disorders, complete coagulation should be done at least once a day.

Cardiopulmonary X-ray.

Differential diagnosis

With stings caused by other insects

Diagnosis of complications

Rhabdomyolysis: muscle swelling, urine gradually darkens, red and less, CK, liver enzymes increase, there is myoglobinuria.

Hemolysis: red urine, blood centrifugation shows red serum, blood count shows reduced red blood cells, red blood cell fragments, increased bilirubin, increased serum iron...

Acute renal failure: urine gradually decreased, oliguria or anuria, urea, blood creatinine increased.

Pulmonary hemorrhage, acute pulmonary edema.

Treatment

If you have anaphylaxis, you will be treated according to the anaphylactic shock treatment protocol of the Ministry of Health.

Prevention of acute renal failure

For patients with less than 10 nodules, let the patient drink a lot of water, 1500-2000ml of water/day, Oresol should be used.

For patients with more than 10 nodules. Administer early and abundant fluids to limit renal failure.

Enhance detoxification by active diuresis (see the practice of acute poisoning).

Hemodialysis

If diuresis, diuresis is not effective, renal failure, intermittent hemodialysis.

If the sting is > 20 nodules and signs of bee venom poisoning, dialysis is indicated as soon as possible to remove the venom, possibly artificial kidney or continuous dialysis (CVVH).

When there is liver failure, renal failure, coagulopathy, plasma exchange and continuous dialysis are indicated.

Coagulation disorders, anemia, thrombocytopenia: transfusion of fresh frozen plasma, red blood cells, platelets or fresh whole blood, depending on the patient's condition.

Respiratory failure: due to acute pulmonary edema, pulmonary bleeding: high-dose oxygen ventilation, CPAP+PS noninvasive mechanical ventilation, or intubation, mechanical ventilation with PEEP. Dialysis can be drained if the volume is increased.

Pain relief with topical Phenergan ointment 2-3 times a day or Eumovate cream applied twice a day.

Efferalgan codeine 0.5g: 3-4 tablets/day.

Vaccinate against tetanus if the bee sting site is contaminated (SAT 2000 subcutaneous units).

Remove the stinger from the patient's skin: if a honey bee stings, remove it soon after being stung.

Mild allergies (urticaria): oral or injected antihistamines, corticosteroids.

Note: when there are many nodules, it is recommended to immediately inject adrenaline 0.3-0.5ml of 1/1000 solution intramuscularly or subcutaneously and diphenhydramine 50mg (because it is difficult to distinguish whether it is due to anaphylaxis or systemic toxicity). . Combination antihistamine (Pipolphen or Dimedrol).

Prevention

For people with atopic allergies, especially those with a history of allergy to bees, have ready a prefilled syringe with adrenalin (EpiPen contains: 0.3mg, EpiPen Jr. contains 0.15mg) for subcutaneous injection if affected. Bee sting.

When entering the forest, you should not spray perfume, makeup and wear colorful clothes because it will attract bees.

Do not disturb the hive.

Related articles:

- Bee stings are a common outdoor nuisance.

- Home remedies for Bee Stings: What works?

- Bee venom is used to hyposensitize individuals highly sensitive to bee stings.