Acute renal failure and/or rhabdomyolysis due to multiple bee stings: A retrospective study

Abstract

Although multiple bee stings are of rare incidence, they can cause many harmful reactions in humans. Massive inoculation of bee venom is reported to cause skin necrosis, shock hypertension, bleeding, hemolysis, thrombocytopenia, pancreatitis, (adult) respiratory distress syndrome, rhabdomyolysis, and acute renal failure (ARF).[1–12] Generally, three major reactions occur after bee inoculation as 1) local swelling and irritation, 2) generalized anaphylactic responses, and 3) serum sickness like symptoms, which include hemolysis, disseminated intravascular coagulation, rhabdomyolysis, and ARF.[13,14] In India, existences of honey combs are general in rural as well as urban areas but there are sparse data available in the literature on bee sting toxicity. To the best of our knowledge, there are no epidemiological studies reported until now on multiple bee sting-induced ARF and/or rhabdomyolysis in the Indian population. Hence, we performed a retrospective study for multiple bee sting-induced ARF and/or rhabdomyolysis. The cases under International Classification of Diseases 2010 (Code T63.4) i.e., “venom of other arthropods” were screened retrospectively from January 2009 to December 2011 after Institutional Ethics Committee (IEC) approval. A total 32 cases were found. The inclusion criteria were the adult cases diagnosed to have multiple bee sting-induced rhabdomyolysis, ARF and/or other complication. Nine cases were selected in the study [Table 1, Figure ​Figure11 and ​and2],2], out of which six were diagnosed with acute kidney injury (AKI) and rhabdomyolysis, two with AKI only, and one with rhabdomyolysis only. The following type of information was collected from the patient records: Age, sex, complaints on admission, diagnosis, medical, medication, social and family history, days between bee stings and hospital admission, number of hemodialysis given, length of stay in the hospital; laboratory results like serum urea, serum creatinine, aspartate (AST), and alanine (ALT) aminotransferases, alkaline phosphatase (ALP), creatine kinase (CK), lactate dehydrogenase (LDH), total leukocyte count (TLC), hemoglobin (Hb), presence of myoglobin in urine, and other relevant data as per the case were obtained. All the patients had no significant abnormalities in serum potassium and sodium. The distribution of the AKI cases as per the risk, injury, failure, loss, end-stage (RIFLE) criteria was 1-‘Risk’, 6-‘Failure’, 1-‘Loss’. Table 1 Details of the patients Figure 1 Serum urea levels of the patients Figure 2 Serum creatinine of the patients The unique points in each case are discussed below. In all the cases, for anaphylaxis standard treatment was given.