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Unusual case of recurrent hypoglycaemia in multiple bee sting envenomation
  1. Kumaresh Pillur Tamilarasu,
  2. Takshak Shankar and
  3. Ankita Kabi
  1. Emergency Medicine, All India Institute of Medical Sciences—Rishikesh, Dehradun, Uttarakhand, India
  1. Correspondence to Dr Ankita Kabi; ankitakabi{at}


A bee sting can result in allergic and toxin-mediated local manifestations like pain, swelling, redness and itching to serious systemic effects like acute kidney injury (AKI), pancreatitis, Kounis syndrome and stroke. Melittin and phospholipase A2, which make up 62% of honeybee venom, have vasoactive, haemolytic properties causing severe AKI. Its role in lowering blood glucose in diabetics is an interesting research topic. We report an elderly herdsman, a known diabetic on irregular oral hypoglycaemic drugs, who presented with altered mental status due to hypoglycaemia. On further prodding, a recent multiple bee sting attack 5 days ago was found which was followed by altered coloured urine for 2 days for which no medical attention was sought. Additional analyses revealed reticulocytosis, azotemia and high serum creatine phosphokinase. The patient was treated with dextrose infusion, antihistamines, fluids and haemodialysis. Renal failure resolved completely and the patient was discharged in a stable condition.

  • poisoning
  • diabetes

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  • Contributors KPT—conception of the work, drafting the article and final approval of the version to be published. TS—collection of data and case details, drafting the article and final approval of the version to be published. AK—critical revision and final approval of the version to be published. All authors read and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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