Wasp Stings Workup

  • Author: Carl A Mealie, MD, FACEP, FAAEM; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Feb 4, 2011
 

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.
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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.
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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.
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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.

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Contributor Information and Disclosures
Author

Carl A Mealie, MD, FACEP, FAAEM  Assistant Professor, Department of Emergency Medicine, Albert Einstein College of Medicine; Chief of Operations, Department of Emergency Medicine, Long Island Jewish Medical Center

Carl A Mealie, MD, FACEP, FAAEM 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 II, MD  Fellowship Program Director, Department of Endocrinology and Metabolism, Henry Ford Hospital

Max Vernon Wisgerhof II, MD is a member of the following medical societies: American Thyroid Association and Endocrine Society

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Timothy D Rice, MD  Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, St 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

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

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A paper wasp (Randy Park, MD)
A paper wasp (Randy Park, MD)
 
 
 
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