Massive hymenoptera XXXX in a 3-year-old.

@entity1 @entity3933 @entity3974 @entity5157 @entity4 @entity391 @entity619 @entity1286 @entity1011 @entity1363 @entity204 @entity1371 @entity110 @entity5900
BACKGROUND: Envenomation by a large number of hymenopterans can cause significant morbidity and mortality due to venom load. We present the first case of massive Hymenoptera @entity5900 by native US Hymenoptera. CASE: A 3-year-old @entity1 and his family were hiking in Oregon and were attacked by yellow jackets. On emergency department arrival, the @entity1 was uncomfortable and @entity391 . Vital signs were normal; physical examination showed more than 90 punctate lesions on the head and neck, and 30 below the neck without @entity110 . Initial laboratory values were normal except for a white blood cell count of 37,500/ L and mild @entity1371 , including a normal @entity1011 kinase. Intravenously administered fluids, @entity3974 , @entity1363 , and @entity1286 were given for symptom control.Generalized @entity4 developed 12 hours later and was treated with intravenously administered @entity619 and @entity3933 . His @entity1011 kinase peaked at 2085 U/L after 32 hours. Forty-eight hours after the incident, the @entity1 began to take oral fluids with laboratory values returning to normal. DISCUSSION: Delayed toxic effects of mass @entity5900 are due to direct toxic effects from the large venom load, with several cases of @entity204 reported. All prior cases of mass Hymenoptera @entity5900 in the United States have involved Africanized "killer" @entity5157 . Guidelines recommend admitting all pediatric @entity1 sustaining more than 50 stings for 24 hours for laboratory evaluations. CONCLUSIONS: Delayed toxic reaction may be caused by native US species of Hymenoptera. Physicians should be aware that endemic US species can cause this reaction and should have a low threshold to admit pediatric @entity1 with more than 50 stings for 24 hours.
