What is the treatment for rhabdomyolysis caused by a bee sting?

Treatment for Rhabdomyolysis from Bee Sting

Aggressive intravenous fluid resuscitation with alkaline diuresis is the cornerstone of treatment for bee sting-induced rhabdomyolysis, as early intervention is vital to protect renal function and prevent mortality. 1

Immediate Recognition and Assessment

Rhabdomyolysis following bee stings is a rare but potentially fatal complication that requires high clinical suspicion. 1 Clinicians must be alert for:

• Generalized body and muscle pain following bee sting exposure 1
• Multiple stings (typically >100) which dramatically increase risk of toxic reactions from massive envenomation 2, 3
• Laboratory evidence: Elevated creatine kinase, myoglobinuria, and acute kidney injury 4

The mechanism differs from typical allergic reactions—this is a toxic reaction from venom load, not anaphylaxis, though both can coexist. 5

Primary Treatment Protocol

Fluid Resuscitation and Alkaline Diuresis

Initiate aggressive intravenous hydration immediately with alkaline diuresis to prevent acute renal failure. 1 This is the most critical intervention and must begin as soon as rhabdomyolysis is suspected.

• Early onset alkaline diuresis is vital in protecting renal functions and preventing morbidity and mortality 1
• The goal is to maintain high urine output and alkalinize urine to prevent myoglobin precipitation in renal tubules 1

Renal Replacement Therapy

Hemodialysis should be initiated promptly in patients with:

• Oliguria or anuria 4
• Severe electrolyte abnormalities 4
• Volume overload 4
• Uremic symptoms 4

Evidence shows that hemoperfusion combined with continuous hemodialysis improves outcomes in severe cases. 5 In one series, 10 of 11 patients with wasp sting-induced AKI required hemodialysis with a mean of 8.7 sessions. 4

Corticosteroid Therapy

Consider pulse-dose corticosteroids as part of comprehensive management, particularly when acute interstitial nephritis is suspected. 5, 4

• Renal biopsy may be indicated in patients not responding to supportive measures to guide steroid therapy 4
• Timely steroid administration in cases of acute interstitial nephritis improves renal survival 4

Multi-Organ Monitoring

Bee sting-induced rhabdomyolysis can progress to multi-organ dysfunction. Monitor for: 5

• Intravascular hemolysis (may coexist with rhabdomyolysis) 4
• Hepatic dysfunction 1
• Coagulation abnormalities 5
• Myocardial damage 5
• Acute anaphylaxis (requires immediate epinephrine if present) 5

Critical Pitfalls to Avoid

Do not delay treatment waiting for laboratory confirmation—clinical suspicion based on multiple stings and muscle pain should trigger immediate aggressive hydration. 1 The mortality rate is significant when treatment is delayed. 6, 5

Do not confuse this with simple allergic reaction—while anaphylaxis has established protocols (epinephrine), the inflammatory and toxic response from massive envenomation demands a tailored approach focused on preventing renal failure. 6

Do not underestimate the severity—cases with approximately 500 bee stings have proven fatal despite intervention, emphasizing the importance of prompt and appropriate treatment. 6

Prognosis with Appropriate Treatment

With early recognition and aggressive management:

• Most patients recover normal renal function (9 of 10 survivors in one series) 4
• Some may progress to chronic kidney disease 4
• Mortality occurs primarily in cases of delayed treatment or overwhelming envenomation 6, 5

The key determinant of outcome is speed of intervention—early alkaline diuresis, timely dialysis when indicated, and comprehensive supportive care can effectively improve prognosis and increase treatment success rates. 5