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Wasp Stings: Differential Diagnoses & Workup

Author: Carl A Mealie, MD, Assistant Professor, Department of Emergency Medicine, Albert Einstein College of Medicine; Medical Director of Emergency Care Institute, Chief of Clinical Operations, Department of Emergency Medicine, Long Island Jewish Medical Center
Coauthor(s): Alan S Multz, MD, Associate Professor of Clinical Medicine, Albert Einstein College of Medicine; Program Director, Internal Medicine Residency, Associate Chairman, Department of Medicine, Long Island Jewish Medical Center; Max Vernon Wisgerhof, MD, Fellowship Program Director, Department of Endocrinology and Metabolism, Henry Ford Hospital
Contributor Information and Disclosures

Updated: Jun 17, 2009

Differential Diagnoses

Anaphylaxis
Pulmonary Edema, Cardiogenic
Angina Pectoris
Pulmonary Edema, Neurogenic
Angioedema
Pulmonary Embolism
Anxiety Disorders
Septic Shock
Asthma
Serum Sickness
Cardiogenic Shock
Shock, Distributive
Food Allergies
Shock, Hemorrhagic
Foreign Body Aspiration
Snakebite
Hymenoptera Stings
Sudden Cardiac Death
Hypersensitivity Pneumonitis
Syncope
Hypersensitivity Reactions, Delayed
Tension Pneumothorax
Hypersensitivity Reactions, Immediate
Toxicity, Mushroom
Injecting Drug Use
Urticaria
Multisystem Organ Failure of Sepsis
Wasp Stings
Panic Disorder
Peritonsillar Abscess

Other Problems to Be Considered

Sudden death syndrome: 23% of patients who experience sudden death syndrome had elevated levels of immunoglobulin E (IgE) in their sera.

Workup

Laboratory Studies

  • Laboratory data are usually not helpful in patients with mild symptoms. Patients who present with anaphylaxis resulting from a wasp sting may benefit from studies such as arterial blood gas, CBC count, electrolytes, BUN and creatinine, glucose, and liver function studies in order to provide their baseline values as part of the admission profile.
  • CBC count: Patients may have mild leukocytosis related to demargination from catecholamine release.
  • Arterial blood gas values reflect the pathophysiology of the illness progression. The initial pH level should be normal or may be slightly elevated to reflect a respiratory alkalosis due to anxiety-produced hyperventilation with the corresponding decrease in the partial pressure of carbon dioxide (PCO2). As the patient becomes more hypotensive, the pH level may begin to fall. Conversely, this fall may also be due to increased respiratory distress with bronchospasm. This can be due to several factors. A respiratory acidosis can be caused by carbon dioxide retention from the respiratory bronchospasm and the development of pulmonary edema. At this point, the partial pressure of oxygen (PO2) level begins to fall. The decreased pH level can also be due to the development of a metabolic acidosis as the patient becomes more hypotensive and tissue perfusion decreases.

Imaging Studies

  • Lateral neck radiography to evaluate for soft tissue swelling may be helpful in patients who experience throat tightness after a wasp sting, although direct fiberoptic visualization of the airway (eg, with a Machida scope) is optimal.
  • Perform chest radiography in patients who present with dyspnea or chest tightness or who have an anaphylactic episode after a wasp sting. Chest radiography should be obtained by using a portable machine in the emergency department (ED) with equipment for aggressively managing the airway close to the bedside.

Other Tests

  • Perform an ECG on patients who experience palpitations, chest tightness, dyspnea, or lightheadedness after a wasp sting.
  • A baseline peak flow measurement helps to assess the progression of distress in patients who present with wheezing, dyspnea, or prolongation of the expiratory phase of respiration after a wasp sting.

Procedures

Flexible fiberoptic visualization of the larynx and vocal chords may be useful to exclude laryngeal edema or spasm. This should be performed by a clinician experienced in emergency airway management; use caution to avoid precipitating laryngospasm.

More on Wasp Stings

Overview: Wasp Stings
Differential Diagnoses & Workup: Wasp Stings
Treatment & Medication: Wasp Stings
Follow-up: Wasp Stings
Multimedia: Wasp Stings
References
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References

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Further Reading

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Keywords

wasp stings, wasp, wasp insect, bee stings, insect stings, wasp venom, Hymenoptera stings, Hymenoptera bites, yellow jacket stings, wasp envenomation, Vespidae stings, urticaria, Hymenoptera, Vespidae, wasp bite

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Contributor Information and Disclosures

Author

Carl A Mealie, MD, Assistant Professor, Department of Emergency Medicine, Albert Einstein College of Medicine; Medical Director of Emergency Care Institute, Chief of Clinical Operations, Department of Emergency Medicine, Long Island Jewish Medical Center
Carl A Mealie, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physicians, American Medical Association, New York Academy of Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Alan S Multz, MD, Associate Professor of Clinical Medicine, Albert Einstein College of Medicine; Program Director, Internal Medicine Residency, Associate Chairman, Department of Medicine, Long Island Jewish Medical Center
Alan S Multz, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Thoracic Society, and Society of Critical Care Medicine
Disclosure: Astellas Pharmaceutical Honoraria Consulting; Merck Pharmaceutical Honoraria Speaking and teaching; The Medicines Company Honoraria Consulting; Schering Plough Honoraria Speaking and teaching; Wyeth Pharmaceuticals Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Max Vernon Wisgerhof, MD, Fellowship Program Director, Department of Endocrinology and Metabolism, Henry Ford Hospital
Max Vernon Wisgerhof, MD is a member of the following medical societies: American College of Physicians, American Diabetes Association, American Thyroid Association, and Endocrine Society
Disclosure: Nothing to disclose.

Medical Editor

Lisa Kirkland, MD, FACP, CNSP, MSHA, Assistant Professor, Department of Internal Medicine, Division of Hospital Medicine, Mayo Clinic; ANW Intensivists, Abbott Northwestern Hospital
Lisa Kirkland, MD, FACP, CNSP, MSHA is a member of the following medical societies: American College of Physicians, Society of Critical Care Medicine, and Society of Hospital Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
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