Pediatric Emergency Department, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel.
Eur J Pediatr. 2010 Oct;169(10):1227-31. doi: 10.1007/s00431-010-1209-4. Epub 2010 May 12.
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.
多种膜翅目昆虫蜇伤可导致横纹肌溶解症、肝酶升高、凝血异常、肾损伤，甚至死亡。然而，其临床和实验室检查结果的进展主要在散发病例报告中描述。我们报告了 6 例儿童在 12 年期间因多次膜翅目昆虫蜇伤而住院并接受肾脏病学评估和随访的临床和实验室表现。1 例患者在蜇伤后 13 小时死亡。在 5 例存活患者中，我们发现了类似的临床和实验室病程模式：横纹肌溶解症伴肝酶升高是最早的表现，随后是肾损伤和贫血。蜇伤事故和严重肾损伤之间可能会出现几天无症状期。该病程具有很强的季节性关联，6 例事件均发生在 8 月或 9 月。在儿童发生多种膜翅目昆虫蜇伤后，预计会出现可预测的临床和实验室病程，需要进行初始实验室评估，甚至在无症状儿童中，也强烈建议重复进行实验室评估。
