title: Multiple hymenoptera stings in children: clinical and laboratory manifestations.
abstract: Multiple hymenoptera stings are a cause of rhabdomyolysis, elevated liver enzymes, clotting abnormalities, kidney injury, and even death. However, the progression of the clinical and laboratory findings has been described mainly in sporadic case reports. We report the clinical and laboratory manifestations of multiple hymenoptera stings in six children who were hospitalized and referred for a nephrology evaluation and follow-up over a 12-year period. One patient succumbed 13 h after the stinging accident. In the five surviving patients, we found somewhat similar pattern of clinical and laboratory course: rhabdomyolysis with elevated liver enzymes are the earliest manifestations, followed by kidney injury and anemia. An asymptomatic phase of several days between the stinging accident and severe kidney injury can occur. There was a strong seasonal association, with all six events occurring in August or September. In children with multiple hymenoptera stings, a somewhat predictable clinical and laboratory course is expected and an initial laboratory evaluation is needed, and even in asymptomatic children, a repeated laboratory evaluation is highly recommended.
authors.affiliation: Pediatric Emergency Department, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel. broides@bgu.ac.il
authors.forename: Arnon
authors.initials: A
authors.lastname: Broides
authors.forename: Michal S
authors.initials: MS
authors.lastname: Maimon
authors.forename: Daniel
authors.initials: D
authors.lastname: Landau
authors.forename: Joseph
authors.initials: J
authors.lastname: Press
authors.forename: Matitiahu
authors.initials: M
authors.lastname: Lifshitz
mesh_terms: D000740:Anemia / Q000209:etiology*; D000818:Animals; D002648:Child; D018450:Disease Progression; D005260:Female; D006801:Humans; D006927:Hymenoptera; D007223:Infant; D007299:Insect Bites and Stings / Q000150:complications* / Q000401:mortality; D008111:Liver Function Tests; D008297:Male; D051437:Renal Insufficiency / Q000209:etiology*; D012189:Retrospective Studies; D012206:Rhabdomyolysis / Q000209:etiology*; D012621:Seasons
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