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Mwandishi:

ULY CLINIC

Mhariri:

ULY CLINIC

Imeboreshwa:

20 Oktoba 2026, 15:06:27

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Bee and Wasp Stings Management

Bee venom contains haemolytic enzymes, neurotoxic factors, histamine and lytic peptides; wasp venom contains hyaluronidase and serotonin.

Prevention of complications after a sting

  • Move the person to a safe area to prevent more stings.

  • Remove stingers promptly by scraping gently with a card, gauze or fingernail.

  • Wash with soap and water and apply a cold compress or ice pack wrapped in cloth.

  • For local irritation apply hydrocortisone 0.5–1% cream, calamine lotion or baking soda paste.

Clinical presentation

  • Local: pain, itching, redness, swelling, cellulitis.

  • Systemic: generalised oedema, fatigue, nausea, vomiting, fever, diarrhoea, dizziness, hypotension, haemolysis, rhabdomyolysis, haemoglobinuria or myoglobinuria, anaphylaxis, loss of consciousness.

Non-pharmacological management

  • Assess airway, breathing and circulation; remove stingers; elevate the limb; clean the wound; watch for anaphylaxis.

Pharmacological management

Indication

Management

Anaphylaxis (first line)

A: Epinephrine (IM) 0.5 mg (0.5 ml of 1:1000) into the anterolateral thigh in adults, repeated every 5–15 minutes if needed; children 0.01 mg/kg IM (maximum 0.5 mg)

Allergic symptoms or itching

A: Chlorpheniramine (PO): adults 4 mg every 4–6 hours (max 24 mg/day); children 2–6 years 1 mg (max 6 mg/day); 6–12 years 2 mg (max 12 mg/day)

Alternative antihistamine

A: Promethazine 6.25–12.5 mg PO/PR before meals and at bedtime, or 25 mg PO/PR at bedtime, or 25 mg IM/IV once (repeat after 2 hours if needed)

Non-sedating antihistamine

C: Loratadine: children 2–5 years 5 mg once daily; 6 years and above 10 mg once daily

Hypotension or shock

A: Sodium chloride 0.9% IV 10–20 ml/kg bolus

Pain or fever

A: Paracetamol (PO): adults 1 g every 8 hours for 48 hours; children 15 mg/kg every 8 hours for 48 hours

Severe respiratory or cardiovascular reaction

D: Methylprednisolone (IV) 125 mg once

  • Observe patients with multiple stings for at least 24 hours for delayed toxicity: adults with more than 50 stings, children with more than 1 sting per kg body weight, or anyone with systemic symptoms.

  • Admit anyone with respiratory distress, hypotension, anaphylaxis, rhabdomyolysis, haemolysis or kidney impairment, whatever the number of stings.

Imeandikwa:

20 Oktoba 2026, 15:06:27

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