Honey bee belong Family- Hymenoptera Sub Family-Apidae Only the females have adapted a stinger from

the ovipositor on the posterior aspect of the abdomen

Histamine.

Melittina –membrane active polypeptide that can cause degranulation of basophils and mast cells, constitutes more than 50 percent of the dry weight of bee venom

Venom commonly causes pain, slight erythema, edema, and pruritus at the sting site

Local reaction Toxic manifestation and anaphylaxis Delayed reaction –Serum sickness

Immediate removal is the important principle and the method of removal is irrelevant.

Sting site should be washed thoroughly with soap and water to minimize the possibility of infection.

Intermittent ice packs at the site- diminish swelling and delay the absorption of venom while limiting edema.

Oral antihistamines and analgesics may limit discomfort and pruritus.

Nonsteroidal anti-inflammatory drugs (NSAIDs) can be effective in relieving pain

Epinephrine 0.3 to 0.5 mg (0.3 to 0.5 mL of 1:1000 concentration) in adults and 0.01 mg/kg in children (never more than 0.3 mg).

Injected IM and the injection site massaged to hasten absorption

If hypotension,severe bronchospasm or laryngeal edema give 0.5 ml of adrenaline diluted in 20 ml of isotonic saline over 20 mins

Observation for 24 hours in ICU

Parenteral antihistamines (diphenhydramine 25 to 50 mg IV, IM, or PO) and H2-receptor antagonists (ranitidine 50 mg IV)

Steroids (methylprednisolone 125 mg) -to limit ongoing urticaria and edema and may potentiate the effects of other measures.

Bronchospasm is treated with -agonist

nebulization.

Hypotension -massive crystalloid infusion, and central venous

pressure monitoring may be helpful in these patients.

-Persistent hypotension require dopamine. -If dopamine is ineffective, an intravenous infusion

of epinephrine can be used

Every patient who has had a systemic reaction -insect sting kit containing premeasured epinephrine and be carefully instructed in its use.

Patient must inject the epinephrine at the first sign of a systemic reaction.

Medic alert tag

Scorpions have a world-wide distribution.

Highly toxic species are found in the Middle East, India, North Africa, South America, Mexico, and the Caribbean island of Trinidad.

Venom can open neuronal sodium channels and cause prolonged and excessive depolarization

Somatic and autonomic nerves may be affected

Initial pain and paresthesia at the stung extremity that becomes generalised

Cranial nerve- abnormal roving eye movements, blurred vision, pharyngeal muscle incoordination and drooling and respiratory compromise

Excessive motor activity

Nausea, vomiting, tachycardia, and severe agitation can also be present.

Cardiac dysfunction, pulmonary edema, pancreatitis, bleeding disorders, skin necrosis, and occasionally death can occur

Pain Management Ice pack Immobilization of limb Local anaesthetics are better than opiates

Tetanus prophylaxis, wound care and antibiotics

Benzodizepines for motor activity.

Stabilize Airway Breathing and Circulation

Hyperdynamic circulation Always combination of alpha blocker with beta

blocker to prevent unopposed alpha action causing tachycardia

Nitrates for Hypertension/MI

Hypodynamic Circulation: CVP guided fluids Decrease preload with furosemide (not

hypovolumic) Reduction of afterload improves outcome-Prazosin,

nitroprusside, hydralizine, ACE inhibitor

Dobutamine is the best inotrope, avoid Dopamine

Noradrenaline can be used

Insulin has shown to improve cardiopulmonary status in case of scorpion envenomation