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Abstract: SA-PO059

NephrotoxSTINGs: Envenomation Syndrome Caused by Bees

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials

Authors

  • Rivera, Maria Eugenia, Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Vega-Colon, Jesus Daniel, Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Rivera Gonzalez, Alexis, Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Ocasio Melendez, Ileana E., Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Andujar-Rivera, Krystahl Z., Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Rivera-Bermudez, Carlos G., Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
Introduction

Hymenoptera stings may result in a wide range of presentations varying from localized pain to systemic reaction, organ dysfunction and multiple organ failure. Rhabdomyolysis and Acute Kidney Injury are rare manifestations of envenoming syndrome following bee stings.

Case Description

An 80-year-old male presented with facial and neck swelling after having been stung by more than 200 beeswhile working in his backyard during the morning. On scene, patient was treated with epinephrine for suspected anaphylactic reaction. Medical history remarkable for hypothyroidism, ischemic cerebrovascular accident, major depression, and anxiety. Home medications included levothyroxine, lorazepam and paroxetine. No previous history of renal disease. Vital signs with blood pressure 158/92 mmHg, heart rate 104 beats per minute, respiratory rate 20 breaths per minute, oxygen saturation 98% at room air, temperature 36.5°C and weight 58 kg. Physical exam was remarkable for a frail male with multiples stingers present on his face, scalp, bilateral upper and lower extremities, and chest. He had marked periorbital, lips and neck swelling without airway obstruction. Foley catheter with 100 mL of cola colored urine. Laboratory results were significant for leukocytosis of 16.88 cells/µL, BUN 23.7 mg/dL, creatinine 1.31 mg/dL, bicarbonate 20.3 mmol/L, CPK 7,570 U/L, urinalysis with proteinuria of 500 mg/dL and blood 3+ but 0-3 RBC cells/hpf, bilirubin 4.12 mg/dL with elevated liver enzymes. Shortly after admission, despite medical management, renal parameters aggravated, concomitant with anuria, hyperkalemia and metabolic acidosis requiring kidney replacement therapy. After 3 weeks of intermittent hemodialysis, renal function recovered.

Discussion

Envenoming syndrome is a rare condition that carries significant morbidity and mortality when presents with multiple Hymenoptera stings. Due to small volume of distribution, elderly patients are at a major risk of severe complications as in our case that patient complicated with hepatic dysfunction, rhabdomyolysis, and acute kidney failure.