Snakebite, scorpion and envenomation

Bee, wasp and hornet stings

Reviewed Nov 2026·1 references
New· views rounded down, updated weekly

Most sting deaths are from anaphylaxis, treated with IM adrenaline. Massive envenomation from multiple stings causes delayed toxicity – rhabdomyolysis, haemolysis, AKI, myocardial injury – even without allergy; monitor for 24 h.

At the bedside

Timed steps
  1. 1

    Immediately

    Anaphylaxis

    Adrenaline 0.5 mg IM (0.01 mg/kg child), repeat every 5-15 min; lie flat, oxygen, IV fluid boluses.

  2. 2

    Promptly

    Remove stings

    Scrape or pluck; speed matters more than method.

  3. 3

    Risk stratify

    Multiple stings

    Dozens to hundreds of stings: check CK, haemoglobin, LDH, bilirubin, creatinine, troponin, urine myoglobin; monitor 24 h.

  4. 4

    Organ care

    Supportive

    Hydrate for rhabdomyolysis, RRT for AKI, treat hyperkalaemia; delayed ARDS and myocarditis possible.

  5. 5

    Allergy

    Discharge

    Refer for allergy evaluation and venom immunotherapy; teach adrenaline autoinjector use where available.

Red flag · call your senior now
Stridor, hypotension or wheeze after a sting: anaphylaxis.
Red flag
Dark urine after multiple stings: rhabdomyolysis/haemolysis.
Pitfall
Antihistamine or steroid instead of adrenaline as first-line.
Pearl
Biphasic anaphylaxis can recur within 72 h; observe after severe reactions.

References

  1. 1

    Cardona V, Ansotegui IJ, Ebisawa M, et al. World Allergy Organization anaphylaxis guidance 2020. World Allergy Organ J. 2020;13(10):100472

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Scorpion sting (Indian red scorpion) and prazosin

Educational reference for trained clinicians. Check doses against your hospital protocol and the patient in front of you.