5. Barbosa AN, 2013
Mecanismos de Lesão do Veneno de Abelha
- Diretos: hemólise, rabdomiólise, choque e outros (apamina: neurotóxica)
- Indiretos: 1. Alergênicos (peptídeo 401: degranulação de mastócitos)
2. Complicações das lesões diretas e do choque anafilático
- Insuficiência Renal Aguda (mioglobinúria)
- SARA
- Insuficiência Hepática
- Hemorragias
- Necrose periférica (pele)
- Outros
6. Barbosa AN, 2013
Adjuvant Treatment (General Management)
- Preserve hemodynamic stability and renal function, treat rhabdomyolysis
A. IV hydration: Isotonic saline 20 mL/kg, 2-3 times (2-3 ml/kg/h of urine output)
B. Refractory shock: Norepinephrine or dopamine (vasoactive drugs)
C. Rhabdomyolysis: IV hydration until CPK < 1.000
D. Oliguria and anuria: nephrologist opinion required (dialysis?)
E. Electrolyte disturbances: monitoring and managing Na+, K+, Ca+ e Mg+
F. Alkalization of urine and mannitol induced diuresis: lack of evidence
7. Barbosa AN, 2013
Adjuvant Treatment (Anaphylaxis Management)
- Treat acute hypersensitivity reactions related to the stings and/or the antivenom
A. Anti-histaminics: IV Promethazine 50 mg, repeat 6/6h if necessary
B. Corticoids: IV Hydrocortisone 200 mg, repeat 6/6h if necessary
C. Anaphylactic shock: SC adrenaline 0.5 mg
D. Bronchospasm: Beta-2 agonist inhalers (fenoterol, salbutamol, terbutaline)
E. Pain: Pethidine 50 mg
8. Barbosa AN, 2013
Protocol
- Up to 5 stings: - take out stings carefully
- Topical Hydrocortisone
- Chlorpheniramine 6 mg orally 8/8h
- Hospitalization is not required
- General and Anaphylaxis management
9. Barbosa AN, 2013
Protocol
- More than 5 Stings: - take out stings carefully
- Hospitalization is required
- General and Anaphylaxis management
10. Barbosa AN, 2013
Procedures Day 1 Day 2 Day 5 Day 10 10 d FU 20 d FU 30 d FU
Patient data X
Medical history X
Clinical Examination X X X X X X X
Adverse Effects X X X X X X X
CBC X X X X X X X
Type 1 Urine X X X X X X X
Renal Function X X X X X X X
Liver Function X X X X X X X
Follow-Up
- Others Study Procedures