Bhattarai Urza, Acharya Anil, Shrestha Ram Sharan, Gautam Arun, Anand Ayush, Manandhar Srista, Sharma Sanjib Kumar
Department of Internal Medicine, B.P. Koirala Institute of Health Sciences.
B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
Ann Med Surg (Lond). 2023 Apr 7;85(5):1919-1922. doi: 10.1097/MS9.0000000000000453. eCollection 2023 May.
Delayed reaction following mass hornet envenomation is associated with various clinical manifestations.
The authors present a case of a 24-year-old male from eastern Nepal, who presented following mass envenomation by hornet stings. He had progressive yellowish discoloration of skin and sclera, myalgia, fever, and dizziness. He had passage of tea-coloured urine followed by anuria. Laboratory investigations suggested acute kidney injury, rhabdomyolysis, and acute liver injury. The authors managed the patient with supportive measures and haemodialysis. There was complete recovery of liver and renal function in the patient.
The findings in this patient were similar to other cases reported in the literature. These patients must be managed supportively, with few requiring renal replacement therapy. Most of these patients recover completely. In low-middle-income countries like Nepal, delay in seeking care and delay in reaching care is associated with severe clinical manifestations. Delayed presentation can lead to renal shutdown and mortality; hence, early intervention is simple, and, crucial.
This case highlights the occurrence of delayed reaction following mass envenomation by hornets. Also, the authors show an approach to managing such patients, similar to managing any other case with acute kidney injury. In these cases, an early simple intervention can prevent mortality. It is crucial to train healthcare workers regarding toxin induced acute kidney injury and the importance of early identification and intervention.
黄蜂大量蜇伤后的迟发性反应与多种临床表现相关。
作者报告了一例来自尼泊尔东部的24岁男性病例，该患者因黄蜂大量蜇伤前来就诊。他出现了皮肤和巩膜进行性黄染、肌痛、发热及头晕。随后他排出了茶色尿液，接着出现无尿。实验室检查提示急性肾损伤、横纹肌溶解及急性肝损伤。作者对该患者采取了支持治疗措施并进行血液透析。患者的肝肾功能完全恢复。
该患者的表现与文献中报道的其他病例相似。这些患者必须接受支持性治疗，少数患者需要肾脏替代治疗。这些患者中的大多数可完全康复。在尼泊尔这样的中低收入国家，就诊延迟和到达医疗机构延迟与严重的临床表现相关。延迟就诊可导致肾衰竭和死亡；因此，早期干预简单且至关重要。
该病例突出了黄蜂大量蜇伤后迟发性反应的发生情况。此外，作者展示了处理此类患者的方法，类似于处理任何其他急性肾损伤病例。在这些病例中，早期简单干预可预防死亡。培训医护人员了解毒素诱导的急性肾损伤以及早期识别和干预的重要性至关重要。
