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Kidney Week

Abstract: FR-PO561

Role of Extracorporeal Treatments in Management of Massive Bee Attack

Session Information

Category: Trainee Case Report

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Channis, Basel, University of Texas Health Science Center, San Antonio, Texas, United States
  • Takkar, Chandandeep, University of Texas Health Science Center, San Antonio, Texas, United States
Introduction

Bee stings can cause severe allergic reaction which can be triggered by a single sting, prognosis worsening with increasing number of stings. More than half of the victims who experience multiple bee stings develop Acute Kidney Injury (AKI), which is due to multiple factors, such as intravascular hemolysis, rhabdomyolysis, hypotension and direct renal tubular toxicity of the venom components. We present a case of anuric acute renal failure due to massive bee attack, managed by renal replacement therapy and plasmapheresis.

Case Description

53 year old male with history of hypertension, presented to our facility after an attack from killer bees (reportedly > 2000 bees). Upon initial presentation(16 hours after attack); he was intubated, in shock requiring vasopressors despite fluid resuscitation, and noted to be anuric. Patient was initiated on a high dose continuous renal replacement therapy (CRRT) with CVVHDF promptly after arrival, in conjunction with Plasmapheresis (PLEX),circuits connected in parallel, to manage renal failure as well as potentially assist with bee venom removal. He received 2 sessions of PLEX (days 1,and 3); CRRT for a week, followed by intermittent hemodialysis (iHD) for another two weeks. Partial renal recovery was noticed and patient was discharged home with a Cr of 4.9 mg/dl. Upon follow up 2 weeks later, further improvement of Cr to 2.5 mg/dl was noted.

Discussion

Massive bee stings is a rare cause for hospital admission and AKI. Patients could also present with cardiomyopathy, and multi-organ dysfunction, perpetrated by shock and/or direct toxicity of venom. Short term mortality could approach 25%, particularly in setting of AKI. Bee venom is a heterogenous toxin with molecular weight of toxins ranging from 2.8 to 43 KDa. One of the major toxins, Mellitin (2.8Kda) is water soluble, and potentially dialyzable. Prompt initiation of dialysis with PLEX could offer benefits in removal of bee venom as well as inflammatory mediators. While there is no consensus in the literature regarding mode of dialysis in such setting, a large case series suggested a higher rate of renal recovery in patients who received CRRT (+/-PLEX) versus iHD. Our patient showed promising trend towards full recovery of renal function.

Initial labs
NA (mmol/L)K (mmol/l)Cl (mmol/L)Co2 (mmol/L)BUN (mg/dL)Cr (mg/dL)PHMyoglobin (ng/mL)
1374.810820202.547.27> 1000