Management of Rhabdomyolysis and AKI Secondary to Bee Sting

Immediate First Aid and Anaphylaxis Management

The American Heart Association recommends removing any retained stingers immediately by plucking or scraping, as venom delivery continues for up to 30-60 seconds while embedded in skin 3
The American Heart Association suggests activating emergency medical services immediately if any signs of anaphylaxis develop, such as difficulty breathing, tongue/throat swelling, lightheadedness, vomiting, or disseminated hives 3
The American Heart Association recommends administering epinephrine autoinjector if available and anaphylaxis is present, as this is the primary treatment regardless of triggering agent 3, 4
Washing the sting area with soap and water is recommended 3

The American College of Surgeons recommends administering >6L of intravenous fluids to prevent AKI and need for renal replacement therapy in patients with severe rhabdomyolysis 1, 2
The American College of Surgeons suggests initiating volume resuscitation as early as possible, as delayed initiation is associated with higher rates of AKI development 1, 2
For moderate rhabdomyolysis, administering 3-6L per day of intravenous fluids is recommended 1, 2

Repeated laboratory assessments should be performed, combining plasma myoglobin levels, plasma creatine phosphokinase (CPK) measurements, and potassium (kalemia) measurements 1, 2
Urinary monitoring should include placing a bladder catheter to monitor hourly urine output 1
Monitoring frequency should be every 30 minutes to 1 hour during the first 24 hours 2

The National Kidney Foundation recommends immediately discontinuing all potentially nephrotoxic medications, including NSAIDs, statins, and other medications with nephrotoxic potential 5, 6, 7, 8
Combining three or more nephrotoxins more than doubles AKI risk, with 25% of patients receiving three or more nephrotoxins developing AKI 6, 7, 8

Antihistamines may be used for local reactions, though systemic manifestations take priority 3