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Medical investigations to send in a 20 wasp bite

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wasp sting AND laboratory

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wasp multiple stings evaluation laboratory tests rhabdomyolysis hemolysis acute kidney injury guideline

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https://pmc.ncbi.nlm.nih.gov/articles/PMC4792632

Twenty wasp stings warrants emergency-department assessment and observation, even if the initial symptoms are only local. Multiple stings can cause venom-mediated rhabdomyolysis, intravascular hemolysis, acute kidney injury, liver injury, thrombocytopenia, and coagulopathy, in addition to anaphylaxis.

Investigations to send

Baseline, urgently
  • CBC with platelet count
  • Renal function and electrolytes: urea/BUN, creatinine, sodium, potassium, bicarbonate
  • Blood glucose
  • Liver function tests: AST, ALT, bilirubin, ALP, albumin
  • Urinalysis with microscopy: blood, protein, red cells, dark/pigment urine
  • Creatine kinase (CK/CPK) for rhabdomyolysis
  • ECG, especially if systemic symptoms, abnormal potassium, chest pain, syncope, or older/cardiac patient
Assess hemolysis
  • Peripheral smear
  • LDH
  • Total and indirect bilirubin
  • Haptoglobin, if available
  • Hemoglobin serially if clinically indicated
Assess renal muscle-pigment injury
  • Urine myoglobin, if available
  • Repeat CK, creatinine, potassium, bicarbonate, and urine output monitoring at 6-12 hourly intervals if abnormal or symptomatic.
Coagulation
  • PT/INR, aPTT
  • Fibrinogen and D-dimer if bleeding, shock, thrombocytopenia, extensive systemic toxicity, or concern for DIC.
Conditional tests
  • ABG/VBG with lactate if hypotension, respiratory distress, altered sensorium, severe toxicity, or metabolic acidosis is suspected.
  • Troponin with serial ECG for chest pain, dyspnea, arrhythmia, hypotension, or cardiovascular disease.
  • Chest radiograph only if respiratory symptoms, pulmonary edema, aspiration, or another thoracic diagnosis is suspected.
  • Serum tryptase can be drawn within about 1-4 hours after a suspected anaphylactic episode, but it must not delay adrenaline treatment.

Monitoring

  • Continuous vital signs, oxygen saturation, mental status, and strict hourly urine output.
  • Observe for at least several hours even if initially well, longer or admit if there are any systemic symptoms, abnormal labs, oliguria, dark urine, rising CK/creatinine, hyperkalemia, hypotension, or significant swelling.
Multiple wasp stings have been associated with hemolysis, rhabdomyolysis, hyperkalemia, abnormal liver tests, thrombocytopenia, and coagulation abnormalities; AKI may evolve after the initial presentation. A case-series review of wasp-sting AKI supports checking renal function, urine findings, CK, hemolysis markers, liver tests, platelet count, and coagulation tests.
If there is wheeze, throat tightness, tongue/lip swelling, faintness, vomiting with widespread hives, or low blood pressure: give IM adrenaline immediately and treat as anaphylaxis. Do not wait for investigations.
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