A Case of Massive Envenomation with Bee Sting: A Case Report

REPORTangioedema of both lips without involvement of the soft palate and uvula.The rest of the physical examination was unremarkable.Her initial blood sugar levels were elevated, with a random blood sugar of 409 mg/dL and arterial blood gas suggestive of metabolic acidosis.Her urine dipstick assay was positive for ketones (++).She was started on intravenous (IV) crystalloids with Ringer's lactate at 125 mL/hour and insulin at 0.1 units/kg body weight as diabetic ketoacidosis treatment.Her presentation blood investigations showed a total count of 18,000/cc; serum creatinine was 0.7 mg/dL, aspartate aminotransferase (AST) was 117 U/L, alanine transaminase (ALT) was 37 U/L, an international normalized ratio of 1.22, creatine phosphokinase (CPK) was >8000 U/L, and high sensitivity (HS) troponin I 4700 pg/mL (normal <9 pg/mL).She denied any difficulty in breathing, lightheadedness, or swallowing difficulty.She did not have anaphylaxis or anaphylactic shock.She was administered IV hydrocortisone 100 mg three times a day, IV chlorpheniramine maleate three times a day, IV ranitidine 50 mg three times a day, and IV fentanyl boluses for pain relief.Within the next 4 hours of presentation, dark cola-colored urine was noticed.Urine alkalinization was initiated with 150 mEq of sodium bicarbonate in 1 L of Ringer's lactate, infused at IntroductIonHymenoptera stings include insects from Apidae (bees), Vespidae (wasps and hornets), and Formicidae (ants).The stings typically result in localized erythema, edema, and pain.Complications like acute kidney injury, rhabdomyolysis, thrombocytopenia, liver dysfunction, myocardial infarction, seizures, and acute stroke occur with massive envenomation.Atopic patients, for example, those with allergic rhinitis, bronchial asthma, or prior sensitization to bee venom, can present with anaphylactic reactions like bronchoconstriction.We present a case of a 57-year-old female with massive envenomation from bee stings, who presented to our hospital within hours of the event.