Multiple hymenoptera stings in children: clinical and laboratory manifestations.
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.
Broides
Arnon
A
Pediatric Emergency Department, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel. broides@bgu.ac.il
Maimon
Michal S
MS
Landau
Daniel
D
Press
Joseph
J
Lifshitz
Matitiahu
M
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
J Gen Intern Med. 2007 Jan;22(1):145-7
17351856
J Allergy Clin Immunol. 2009 Jun;123(6):1371-5
19443022
Am J Kidney Dis. 2001 Dec;38(6):E33
11728993
J Allergy Clin Immunol. 1973 Nov;52(5):259-64
4746790
J Allergy Clin Immunol. 2004 Oct;114(4):869-86
15480329
Pediatrics. 2006 Jan;117(1):231-5
16396886
Rev Inst Med Trop Sao Paulo. 2003 Jan-Feb;45(1):45-50
12751323
J Am Soc Nephrol. 2004 Jul;15(7):1862-7
15213274
Toxicon. 2006 Jul;48(1):44-54
16774771
Nephrol Dial Transplant. 1999 Jan;14(1):214-7
10052513
Nephron. 1998;78(2):235-6
9496750
J Toxicol Clin Toxicol. 1995;33(5):471-4
7650773
Pediatr Nephrol. 2005 Dec;20(12):1809-10
16222551
J Fam Pract. 1996 Sep;43(3):271-3
8797755
Vet Q. 1998 Jul;20(3):111-4
9684301
Nephrol Dial Transplant. 2003 Jun;18(6):1235
12748373
Eur J Pediatr. 2009 Aug;168(8):991-4
19148679
Nephrology (Carlton). 2005 Dec;10(6):548-52
16354236
Indian Pediatr. 2007 Oct;44(10):788-90
17998583
J Paediatr Child Health. 1990 Oct;26(5):283-5
2265021