IM21.9 | Bee Sting and Other Envenomation — Summary & Reflection

KEY TAKEAWAYS

Bee/wasp sting — two syndromes:
- Anaphylaxis (single sting, sensitised): urticaria + wheeze + hypotension → adrenaline 0.5 mg IM (anterolateral thigh) FIRST → IV fluids → chlorphenamine + hydrocortisone adjuncts → observe 4–6 h for biphasic.
- Massive toxic envenomation (>50–100 stings, any person): haemolysis + myonecrosis → haemoglobinuria + AKI → aggressive IV fluids (200–300 mL/h, urine output ≥200 mL/h) → CK, creatinine serial monitoring → ICU; NO adrenaline.

Jellyfish: Nematocyst venom → burning pain + linear branching marks. First aid: do NOT rub; remove tentacles with tweezers/card; flush with seawater (not fresh water); apply vinegar (5% acetic acid) 30 min; analgesia.

Centipede: Forcipule venom → local burning pain; supportive: analgesia + ice + tetanus; no antivenom.

Black widow spider (latrodectism): Alpha-latrotoxin → abdominal cramps + muscle rigidity + hypertension + diaphoresis (mimics acute abdomen); treat with opioids + benzodiazepines + antihypertensives; antivenom where available.

Key differentiator: Anaphylaxis = rapid onset + urticaria/bronchospasm + hypotension → adrenaline IM. Toxic massive envenomation = systemic organ injury without urticaria → supportive ICU care.

REFLECT

Reflect on the contrast in the opening hook — 500 stings, no allergy history, gradual organ failure versus 1 sting, no prior exposure (apparently), cardiovascular collapse in minutes. What cognitive principle explains why the clinician's first instinct might be to focus on the dramatic mass-sting patient while the single-sting patient dies first? Think about how the word 'anaphylaxis' — once you recognise it — should trigger an automatic mental action sequence (adrenaline IM, first, before anything else). How might you explain to a rural ASHA worker or village health volunteer the single most important thing to do when a person collapses after a bee sting? Could you translate the anaphylaxis protocol into a 15-second verbal instruction that a non-medical person could act on before the doctor arrives?