Insect bites and Stings

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Majority of serious sting-related reactions belong to the order hymenoptera. These include bees, wasps, spiders, scorpions, ants, hornets and centipedes.

Signs and symptoms

  • Swelling,
  • Discolouration,
  • Burning sensation,
  • Pain at the site of the sting
  • There may be signs of anaphylactic shock

Differential diagnosis

  • Allergic reaction

Treatment objectives

  • Relieve pain
  • Prevent anaphylactic shock
  • Reduce morbidity
  • Prevent complications
  • Neutralize the toxin

Non-pharmacological treatment

  • Apply cold water/ice
  • Clean the area with soap and water to remove contaminated particles left behind by some insects
  • If the sting remains implanted in the skin, carefully remove with a needle or knife blade
  • Assess airway and ensure patency in case of scorpion bite

Pharmacological treatment

To relieve pain

Paracetamol oral

Adult:

500 mg to 1g every 6-8 hours as required

Child: 

6-12 years: 250-500 mg every 6-8 hours or when necessary

3-5 years: 250 mg every 6-8 hours or when necessary

up to 3 years: 125mg every 6-8hours or when necessary

 

OR

Ibuprofen oral

Adult: 400–800 mg every 8 hours for 3 days

Child: 10 mg/kg every 8 hours; maximum 400 mg per day for three days

              

If severe local reaction give:

Chlorphenamine oral

4 mg every 6 hours (max: 24 mg daily) until swelling subsides

Child:

1-2 years: 1 mg every 12 hours

2-5 years: 1 mg every 6 hours (max: 6 mg daily)

6-12 years: 2 mg every 6 hours (max: 12 mg daily)

OR

Promethazine tablet orally

Adult:

25 mg at bedtime or 12.5 mg before meals and at bedtime (dosage range, 6.25-12.5 mg every 8 hr)

Child:

 <2 years contraindicated

2-5 years, 5 mg every 8 hrs

 6-12 years, 12.5 mg every 8 hr

Apply calamine lotion when necessary every 6 hours

 

To prevent anaphylactic shock give:

Adrenaline IV

Adult and child 30 kg (66 lbs) or more

1:10,000, 0.1mg (0.1mg/mL) IV at rate of 1-4 mcg/min over 5 min

Note:

  • Do not administer IV unless the patient fails to respond to several doses of IM
  • Should only be done in cardiopulmonary arrest or if patient is profoundly hypotensive

Adrenaline IM

Child:

<6 years: 150 micrograms (0.15 mL)

6-12 years: 300 micrograms (0.3 mL)                                   

1 in 1000 (1 mg/mL) 0.5 mg (0.5 mL) IM immediately, into anterolateral thigh

Repeat every 5-15 minutes according to BP, pulse rate, and respiratory function until better

 

If very painful scorpion sting

Apply 2 mL of 2% lignocaine around the area of the bite

 

Tetanus prophylaxis

Tetanus toxoid (0.5 mL) immunization if not previously immunized within the last 10 years

Prevention

  • Clear overgrown vegetation/bushes around the home
  • Prevent children from playing in bushes
  • Cover exposed skin while moving in bushes
  • Use pest control methods to clear insect colonies

Referral

  • If there are signs of systemic envenomation immediately refer for specialist care