Gender Differences in Hymenoptera Stings

 

 Substance:

Hymenoptera venom

 Common name:

Bee, wasp, hornet, stings

 

 Involving system:

Immune system: IgE-mediated hypersensitivity [1].

Cardiovascular system: Hypotension, anaphylactic shock [2]

Respiratory system: Bronchospasm, airway edema [3]

Dermatologic system: Urticaria, angioedema, erythema [4, 5]

Neurological/psychological: Panic, fear, anxiety—especially pronounced in females [6].

 

 Presentation:

Most stings cause local reactions (pain, swelling, redness).

Large local reactions (LLRs): >10 cm swelling over 24–48 hours, typically benign. [7]

Systemic reactions (SRs): Include generalized urticaria, dyspnea, hypotension, collapse. [5, 8]

Anaphylaxis: Life-threatening; rapid onset of multisystem involvement.

 

Gender differences:

Females tend to report more severe subjective symptoms (pain, anxiety), and have higher rates of anxiety and PTSD after stings. A significant percentage of stings in females occurred on holidays (47.8% vs. 26.8%, p = 0.008), and drop in DBP was more noticeable in females (76.3 vs. 70.3 mmHg). [5].

Males are more likely to experience systemic reactions, possibly due to occupational/environmental exposure (e.g., agriculture, outdoor work). Males experiencing significantly more Hymenoptera stings (1.3 vs. 1.0, p = 0.049) [5]

Males are also less likely to carry epinephrine autoinjectors and adhere to follow-up, whereas females are more compliant with allergist visits and venom immunotherapy (VIT) [9].

 .

 Antidote / Management:

No specific antidote. 

Wound care, Tetanus Toxoid injection. 

First-line: Intramuscular epinephrine (0.3 mg adult; 0.15 mg pediatric) in SRs [5, 10] 

Supportive care: Oxygen, IV fluids, bronchodilators, corticosteroids, H1/H2 antihistamines [5]

Venom immunotherapy (VIT): Highly effective long-term desensitization for patients with systemic allergic reactions. [9]

 

 Disposition:

Mild local reactions: Discharge with symptomatic care (cold compress, antihistamines, NSAIDs)

Anaphylaxis/systemic reactions: Admit or observe in ED; consider ICU for severe cases

Educate patient and caregivers on sting avoidance, epinephrine use, and emergency action plan

 

References

[1] Sturm GJ, Heinemann A, Schuster C, Wiednig M, Groselj-Strele A, Sturm EM, Aberer W. Influence of total IgE levels on the severity of sting reactions in Hymenoptera venom allergy. Allergy. 2007 Aug;62(8):884-9. doi: 10.1111/j.1398-9995.2007.01413.x. PMID: 17620065.

[2] van der Linden PW, Struyvenberg A, Kraaijenhagen RJ, Hack CE, van der Zwan JK. Anaphylactic shock after insect-sting challenge in 138 persons with a previous insect-sting reaction. Ann Intern Med. 1993 Feb 1;118(3):161-8. doi: 10.7326/0003-4819-118-3-199302010-00001. PMID: 8417633.

[3] Mayer DE, Krauskopf A, Hemmer W, Moritz K, Jarisch R, Reiter C. Usefulness of post mortem determination of serum tryptase, histamine and diamine oxidase in the diagnosis of fatal anaphylaxis. Forensic Sci Int. 2011 Oct 10;212(1-3):96-101. doi: 10.1016/j.forsciint.2011.05.020. Epub 2011 Jun 12. PMID: 21664082.

[4] Colombi S, Cantone R, Massara G, Parachini F, Petrella V, Pastore M, Galimberti M. Reazioni da imenotteri: un problema di pronto soccorso [Reactions caused by Hymenoptera: a first aid problem]. Minerva Med. 1988 Jul;79(7):539-42. Italian. PMID: 3405456.

[5] Yu CH, Tan ST, Yang HW, Lai YC, Su YJ. Gender-Based Clinical Differences in Hymenoptera Venom Poisoning: A Retrospective Study From Taiwan (April 2021 to March 2023). Emerg Med Int. 2025 Jun 2;2025:8893175. doi: 10.1155/emmi/8893175. PMID: 40495953; PMCID: PMC12149513.

[6] Woźniewicz A, Szynkiewicz E, Pałgan K, Graczyk M, Dowbór-Dzwonka A, Bartuzi Z. Fear of stinging insects in relation to state anxiety and trait anxiety in a group of patients with hymenoptera venom allergy undergoing immunotherapy. Postepy Dermatol Alergol. 2019 Aug;36(4):472-477. doi: 10.5114/ada.2018.78808. Epub 2019 Aug 30. PMID: 31616224; PMCID: PMC6791157.

[7] .Bilò MB, Martini M, Pravettoni V, Bignardi D, Bonadonna P, Cortellini G, Kosinska M, Macchia D, Mauro M, Meucci E, Nittner-Marszalska M, Patella V, Pio R, Quercia O, Reccardini F, Ridolo E, Rudenko M, Severino M. Large local reactions to Hymenoptera stings: Outcome of re-stings in real life. Allergy. 2019 Oct;74(10):1969-1976. doi: 10.1111/all.13863. Epub 2019 May 28. PMID: 31074868.

[8].Chang CW, Chen HY, Mao CY, Lin YP, Yang HW, Tan ST, Yu CH, Su YJ. Allergic reactions after Hymenoptera stings in older adults: A multi-center study. Am J Emerg Med. 2025 Apr 25;94:179-184. doi: 10.1016/j.ajem.2025.04.044. Epub ahead of print. PMID: 40318385.

[9].Bilò BM, Bonifazi F. Hymenoptera venom immunotherapy. Immunotherapy. 2011 Feb;3(2):229-46. doi: 10.2217/imt.10.88. PMID: 21322761.

[10]. Sicherer SH, Simons FER; SECTION ON ALLERGY AND IMMUNOLOGY. Epinephrine for First-aid Management of Anaphylaxis. Pediatrics. 2017 Mar;139(3):e20164006. doi: 10.1542/peds.2016-4006. Epub 2017 Feb 13. PMID: 28193791.

Edited by Yu-Jang Su   June 20, 2025, 

                                      June 21, 2025 revised. 

Hymenoptera Stings in Taiwan: Wasps and Bees

 

Substances

Common Names

Wasps (family Vespidae, including hornets and paper wasps)

Bees (family Apoidea, including honeybees)

 

Involved Systems

Immune system (anaphylactic reactions)

Renal system (acute kidney injury from multiple stings) [1]

Hepatic system (elevated liver enzymes) [1]

Muscular system (rhabdomyolysis) [2]

Hematologic system (coagulopathy, hemolysis) 22.5% [3]

 

Presentations

Older adult patients are more frequently stung on the head and upper limbs [1].

Local reactions such as pain, redness, and swelling are more common and milder in bee stings.

Systemic reactions—especially with wasp stings—include anaphylaxis, hypotension, dyspnea, and urticaria. Severe wasp stings can lead to rhabdomyolysis, acute renal failure, liver injury, and disseminated intravascular coagulation (DIC). [1]
Severity factors include advanced age, multiple body regions affected, and a high number of stings (particularly >50). Older patients tend to have slower heart rates (85.7 vs. 92.4 bpm, p = 0.003) and significantly higher creatine kinase (CK) levels (1343.3 vs. 239.5 U/L, p = 0.003) [1]

 

Antidotes / Treatment

Mild to Moderate Cases:

Antihistamines and corticosteroids [1]

Analgesics for pain control [1]

Severe or Anaphylactic Reactions: Intramuscular epinephrine

Intravenous fluids, oxygen, vasopressors if needed

Intensive care support for rhabdomyolysis or renal failure

Hemodialysis in cases of renal impairment

 

Disposition

About 7.5% of Hymenoptera sting cases result in severe or fatal envenomation [4].
Bee stings usually lead to mild outcomes—most patients recover without complications and rarely require hospitalization.
In contrast, wasp stings pose a higher risk for ICU admission and mortality, especially when sting number exceeds 50.

Key severity predictors include:

• Three or more stings (OR: 35.87, p = 0.002) or sting sites (OR: 35.2, p = 0.002) [1]
• Greater number of stings, wasp species, older age, and stings over multiple body regions [4].
  Wasp stings are more frequently associated with life-threatening outcomes in Taiwan, with incidence peaking from late summer to early autumn.
  Although about 25% of systemic allergic reactions are severe, fatal outcomes are rare (0.004) [1].
  
  There is still a need to improve public awareness and the proper use of epinephrine in managing anaphylaxis.

 

References

1.      Chang CW, Chen HY, Mao CY, Lin YP, Yang HW, Tan ST, Yu CH, Su YJ. Allergic reactions after Hymenoptera stings in older adults: A multi-center study. Am J Emerg Med. 2025 Apr 25;94:179-184. doi: 10.1016/j.ajem.2025.04.044. Epub ahead of print. PMID: 40318385.

2.      Lin CC, Chang MY, Lin JL. Hornet sting induced systemic allergic reaction and large local reaction with bulle formation and rhabdomyolysis. J Toxicol Clin Toxicol. 2003;41(7):1009-11. doi: 10.1081/clt-120026527. PMID: 14705851.

3.      Xie C, Xu S, Ding F, Xie M, Lv J, Yao J, Pan D, Sun Q, Liu C, Chen T, Li S, Wang W. Clinical features of severe wasp sting patients with dominantly toxic reaction: analysis of 1091 cases. PLoS One. 2013 Dec 31;8(12):e83164. doi: 10.1371/journal.pone.0083164. PMID: 24391743; PMCID: PMC3877022.

4.      Nguyen TN, Jeng MJ, Chen NY, Yang CC. Outcomes of wasp and bee stings in Taiwan. Clin Toxicol (Phila). 2023 Mar;61(3):181-185. doi: 10.1080/15563650.2023.2173075. Epub 2023 Mar 9. PMID: 36892552.

Edited by Yu-Jang Su May, 6, 2025. 

 

Emamectin Poisoning

 

Substance:

Emamectin – A semi-synthetic avermectin derivative used as an insecticide. It acts by activating glutamate-gated chloride channels in invertebrates, leading to paralysis and death [1].

- Similar to ivermectin, it can also affect GABA-mediated neurotransmission at higher doses. [2]

-a broad-spectrum insecticide [3].

-      Poisoned age: 42.8 to 72 years old. [1, 3, 4]

-      Happened to Male 72.7% [3].

 

Common Names:

Emamectin; commonly found in agricultural products under trade names such as Proclaim, Affirm, or Tree-äge.

It is not intended for human or veterinary use.

因滅汀; 迅雷; 霸蟲清; 治蟲王, 阿巴汀. [5].

 

Involving Systems:

Primarily affects:

-      Potential mechanisms of corrosive injury include skin and eye irritation effects of EMB, the solvents of which might exert corrosive action [1, 6].

-      Central Nervous System (CNS) [1]. 27.3% [3],[4], and [6].  

-      Gastrointestinal System (GI) distress [1] 62.5% [3], and [6].

-      Respiratory symptoms (6.8%) [3]. 9-27 % intubation. [3, and 4].

-      SOB 33% [4].

 

Presentation:

Symptoms vary by dose and individual sensitivity, and may include:

-      Altered mental status, AMS [1] can breach the blood-brain barrier

-      Drowsiness [4], dizziness, ataxia, muscle weakness

-      Sore throat. [1, 6] laryngeal corrosive injuries.

-      22% Nausea, vomiting [4], abdominal pain [5], diarrhea

-       Severe cases: respiratory depression [5], prolonged coma

 

Antidote:

-      No specific antidote available [1]  Supportive care is the cornerstone of treatment:

-      Maintain airway and provide oxygen as needed; intubation in severe cases

-      Monitor and support vital signs

-      Activated charcoal may be administered if within 1 hour of ingestion and no aspiration risk [5].

 

Disposition:

Mild cases: Can be monitored as outpatient for 6 hours;

Asymptomatic patients may be discharged

-Hospitalized (78% to 78.4%) [3, 4].

Moderate to severe toxicity: Requires inpatient observation; ICU care (42%) may be necessary in severe CNS or respiratory depression. [1, 4]

-      2.3% mortality. Consciousness is a prognostic outcome. [3]. A low GCS at presentation and SOB were associated with worse outcomes [4].

 

  

 

References

[1]. Pan CS, Lee CC, Yu JH, Mu HW, Hung DZ, Chen CH. Reassessing clinical presentations of emamectin benzoate poisoning: A comprehensive study. Hum Exp Toxicol. 2024 Jan-Dec;43:9603271241249965. doi: 10.1177/09603271241249965. PMID: 38662433

[2]. Lalmalsawmi R, Ravikumar YS, Mahesh M, Shihuna PMM, Ramesh M, Chalasani SH. Management and prognosis of acute Emamectin Benzoate poisoning in a human. Toxicol Rep. 2024 Sep 21;13:101744. doi: 10.1016/j.toxrep.2024.101744. PMID: 39399096; PMCID: PMC11470463.

[3].Trakulsrichai S, Sittiyuno P, Tansuwannarat P, Tongpoo A. Emamectin Poisoning in Thailand: Clinical Characteristics and Outcomes. Toxics. 2024 Sep 13;12(9):668. doi: 10.3390/toxics12090668. PMID: 39330596; PMCID: PMC11435638.

[4]. Wu YK, Chang CH, Yu JH, Lan KP, Yen TH, Chang SS, Seak CJ, Chang HY, Chen HY. Intentional avermectin pesticide ingestion: a retrospective multicenter study. Clin Toxicol (Phila). 2022 Oct;60(10):1099-1105. doi: 10.1080/15563650.2022.2104729. Epub 2022 Aug 2. PMID: 35916769.

[5]. https://www.sem.org.tw/Ejournal/Detail/549.

[6.]. Pan CS, Chen CH, Mu HW, Yang KW. Review of Emamectin Benzoate Poisoning. J Acute Med. 2024 Sep 1;14(3):101-107. doi: 10.6705/j.jacme.202409_14(3).0001. PMID: 39229355; PMCID: PMC11366691

 

Edited by Yu-Jang Su on April 12, 2025.

 

 

Lantana camara poisoning

 

Substance: Lantana camara, News:  https://www.youtube.com/watch?v=LNrUYoL3N-E

 

Common Name: Common Lantana, 馬纓丹、五色梅、紅黃花、臭草[1]

 

Involving System      

- Gastrointestinal (GI): Acute cases develop hemorrhagic diarrhea. Chronic poisoning results in constipation. [2]

- Hepatic (Liver): Lantana contains lantadene-type toxins (such as lantadene A and B), which can cause hepatocellular injury and may lead to cholestasis [3]. Animal cases: In livestock such as cattle and horses, poisoning commonly results in liver damage and photosensitivity reactions [4]; such effects are rare in humans.

- Renal (less common) [5]

 

Presentation      

Nausea (0.3%), vomiting (4.7%), diarrhea (0.94%), abdominal pain (1.2%) [6]

Abnormal liver function (jaundice, elevated AST/ALT) [7]

Drowsiness (0.5%), weakness [6]

Rare: renal failure, arrhythmias, photosensitivity reactions (more common in animals) [5], [7]

 

Antidote / Treatment     

- （No specific antidote）

-  （Supportive care）activated charcoal [8].

- Intravenous fluids, IVF、correct electrolyte imbalance. [8]

- Liver injury： Hospitalize and monitor the liver enzymes and function.

 

Disposition 

- mild： treatment and observation, discharged when improvement was achieved.

- severe: persisted liver enzymes elevated, or uneasy symptoms:  0.3% hospitalized [6], especially the children and elderly.

 

References 

[1]. https://www.agriharvest.tw/archives/16922

[2]. https://poisonousplants.cvmbs.colostate.edu/plant/64

[3]. https://pubmed.ncbi.nlm.nih.gov/431982/

[4]. https://pubmed.ncbi.nlm.nih.gov/12583691/

[5]. https://pubmed.ncbi.nlm.nih.gov/16031191/

[6]. https://pubmed.ncbi.nlm.nih.gov/21041281/

[7]. https://pubmed.ncbi.nlm.nih.gov/37054993/

[8]. https://pubmed.ncbi.nlm.nih.gov/6512165/

 

Edited by Yu-Jang Su  March 17, 2025 

 

 

 

 

Benzyl Alcohol Intoxication

 

Substance

 

Benzyl Alcohol (C₇H₈O) - A preservative used in medications, cosmetics, and industrial applications. Metabolized in the liver to benzoic acid and hippuric acid, which are eliminated by the kidneys [1].

 

Common Name

Benzyl Alcohol

Found in solution in 注射劑的防腐劑， 照相顯影劑， 墨水、塗料、油漆、環氧樹脂塗料、染料、 明膠等的溶劑， 也用於製取香料和調味劑, 以作為肥皂、香水、化妝品和其他產品中的添加劑.

 

Involving System

Central Nervous System (CNS): Sedation, lethargy, coma, seizures  

Cardiovascular System: Hypotension [2], tachycardia, cardiac collapse Metabolic System: Metabolic acidosis (high anion gap)

Respiratory System: Respiratory depression, Respiratory depression [3].

Moderate poisoning: Severe drowsiness, hypotension, metabolic acidosis

- Severe poisoning: Coma, seizures, respiratory failure, cardiovascular collapse

 

Examination & Diagnosis

- Blood gas analysis: Metabolic acidosis with increased anion gap - Serum benzyl alcohol or benzoic acid levels (if available)

- Electrolytes, lactate, and kidney function tests

- ECG: Arrhythmia evaluation

- Chest X-ray: If respiratory complications are suspected

 

 

Presentation [4].

Mechanism & Metabolism (M)     

Overdose leads to CNS depression, metabolic acidosis, and respiratory failure due to toxic metabolites.

AMS: altered mental status

Acidosis: metabolic acidosis

Hypokalemia, hypophosphatemia

Hyperammonemia.

Neonates are particularly vulnerable due to immature liver metabolism.

 

Antidote

Decontamination & Initial Management

        - Activated charcoal is generally not recommended unless ingestion is recent and in large amounts

- Supportive care is key (IV fluids, oxygen therapy)

Pharmacological Treatment

- Sodium bicarbonate IV to correct metabolic acidosis

- Hemodialysis in severe cases with renal failure or refractory acidosis

- Symptomatic treatment: Vasopressors for hypotension, anticonvulsants for seizures

 

Disposition

Clinical Disposition & Follow-up   

- Mild cases: Observation for 6–12 hours with supportive care

- Moderate to severe cases: ICU admission for ventilatory support and hemodynamic monitoring

- Neonatal cases: Extreme caution, as even small amounts can cause fatal "gasping syndrome" due to toxic accumulation. [5].

Hemodialysis Indications: Severe metabolic acidosis, renal impairment, or refractory symptoms.

 

References

[1]. https://pubmed.ncbi.nlm.nih.gov/3229281/

[2]. https://pubmed.ncbi.nlm.nih.gov/2922508/

[3]. https://pubmed.ncbi.nlm.nih.gov/35787785/

[4]. https://pubmed.ncbi.nlm.nih.gov/35466010/

[5]. https://pubmed.ncbi.nlm.nih.gov/7133084/

 

 Edited by Yu-Jang Su  Feb 5, 2025

Anti-cholinergic syndrome

 

Substance

Typical substances: Atropine, Scopolamine, Promethazine, Antihistamines (e.g., Diphenhydramine), Antipsychotics (e.g., Clozapine), Muscle relaxants (e.g., Cyclobenzaprine), Tricyclic antidepressants (e.g., Amitriptyline, Nortriptyline), Toxic plants (e.g., Datura曼陀羅屬, Deadly Nightshade, Atropa belladonna 顛茄). [1], [2], [3]

 

Common Name

Also known as: Anticholinergic drugs, toxic plants (natural belladonna alkaloids), and antispasmodic agents. Drug for motion sickness. [4]

 

Occasionally observed side effects caused by the combination of anti-motion sickness patches and motion sickness medication during outdoor field trips in Taiwan.

 

Involving System[5]

Central Nervous System (CNS): Agitation, delirium, hallucinations, seizures.

Cardiovascular system: Tachycardia, hypertension.

Respiratory system: Potential respiratory depression. Suppress the central nervous system (CNS) in severe overdose cases, leading to respiratory depression. Bronchodilation, this effect is generally beneficial in conditions like asthma but is not typically clinically significant in overdose.

Urinary system: Urinary retention.

Gastrointestinal system: Dry mouth, decreased bowel motility.

Eyes: Mydriasis (dilated pupils), blurry vision.

 

Presentation[1] [5]

Clinical features:

"Dry as a bone": Dry mouth and skin.

"Red as a beet": Flushed skin.

"Hot as a hare": Hyperthermia.

"Blind as a bat": Dilated pupils and blurred vision.

"Mad as a hatter": Agitation, delirium, hallucinations.

"Full as a flask": Urinary retention.

Decreased bowel sounds or constipation.

Many anticholinergics cannot be directly detected. To trace the contact or medical history

 

Antidote [6]

 

Physostigmine, Neostigmine, 0.5-2 mg as needed, total max.＜5 mg

Mechanism of action: Reversible acetylcholinesterase inhibitor that increases acetylcholine levels to counteract anticholinergic effects.

Caution: Only for severe central nervous system symptoms (e.g., delirium, seizures) and should be used carefully to avoid inducing arrhythmias or seizures.

Delirium:  0.8 to 1.2 mg. [7]

 

Symptomatic treatment:

Cooling measures (e.g., ice packs or cooling blankets).

Cardiovascular support (e.g., beta-blockers for tachycardia).

Sedatives (e.g., benzodiazepines) for agitation or seizures.

 

Disposition[8]

 

Observation and admission:

 

Mild cases: Observe for 6-12 hours.

Moderate to severe cases: Admit to the hospital for treatment, including intensive care monitoring if necessary.

Follow-up management:

 

Provide psychiatric evaluation if poisoning is due to intentional overdose or substance abuse.

Educate patients to avoid repeated exposure to the toxin.

 

References

 

[1]https://pubmed.ncbi.nlm.nih.gov/32310353/

[2]https://pubmed.ncbi.nlm.nih.gov/3290996/

[3]https://pubmed.ncbi.nlm.nih.gov/20930988/

[4]https://pubmed.ncbi.nlm.nih.gov/2239207/

[5]https://www.ncbi.nlm.nih.gov/books/NBK546589/

[6]https://pubmed.ncbi.nlm.nih.gov/25339374/

[7]https://pmc.ncbi.nlm.nih.gov/articles/PMC4767198/

[8]https://pmc.ncbi.nlm.nih.gov/articles/PMC10332772/

 

Edited by Yu-Jang Su  Jan 4, 2025

Bitten by Poecilotheria metallica, 藍寶石華麗雨林

 

Substance (物質)

Poecilotheria metallica

Toxin Type: Venom (神經毒性為主，可能帶有少量細胞毒性成分)

 

Common Name (俗名)

藍寶石華麗雨林

 

Involving System (受影響的系統)

神經系統 (Nervous System): 主要受到毒液中神經毒素影響，導致疼痛及神經異常症狀 [1]

肌肉骨骼系統 (Musculoskeletal System): 咬傷部位可能有肌肉痙攣和強烈疼痛[1]

皮膚及軟組織 (Skin and Soft Tissue): 局部紅腫、疼痛，偶爾出現壞死 [2]

extensive muscle damage on day 5. However, by day 10, the regeneration was evident, and the regeneration process continued until day 20.[3]

 

Presentation (臨床表現)

局部症狀:

-          強烈的刺痛或灼熱感 [2] 紅腫及輕微出血 [2]

在部分病例中，可能有壞死或局部潰瘍

全身症狀:

肌肉痙攣 [1] 神經麻木或刺麻感 [1]

偶爾伴隨頭痛、噁心

心悸或呼吸困難 (罕見，但需密切觀察)

 

Antidote (解毒劑)

目前無特定解毒劑 (No specific antidote available) [2]

對症治療:

局部清創及止痛藥 (如NSAIDs)

抗組胺藥物 (如必要，用於減少局部腫脹和過敏反應)

嚴重情況下可考慮短期使用皮質類固醇

-          atropine, chloropyramine, chlorpromazine, diazepam, ethanol, flupirtine, haloperidol, ketotifen, lamotrigine, oxcarbazepine, tolperisone, xylazine, and CaCl2, helpful to suppress the envenomation symptoms [1] and [4]

 

Disposition (處置建議)

 

-          Poecilotheria fasciata venom effects were studied in detail at a sub-lethal dose of 5 mg/kg (LD50 = 12 mg/kg). [1]

輕症患者 (Mild Cases):

局部清潔傷口並冰敷

使用止痛藥進行緩解

居家觀察，特別注意有無全身症狀發展

 

中重症患者 (Moderate to Severe Cases):

入院觀察 24-48 小時

密切監測神經系統及心肺功能

必要時進行支持性治療 (如氧氣給予或肌肉鬆弛劑) [1]

-          No fatal cases reported so far.  

 

感染風險:

若懷疑有細菌感染，根據感染症狀開始抗生素治療

-          Poecilotheria metallica 的咬傷案例相對少見，但與其他樹蛛類似，其毒液效力偏低，致命性極低。臨床管理以支持性治療和觀察為主，並防止繼發感染。

 

References

 

1.      Andreev-Andrievskiy A, Popova A, Lagereva E, Osipov D, Berkut A, Grishin E, Vassilevski A. Pharmacological analysis of Poecilotheria spider venoms in mice provides clues for human treatment. Toxicon. 2017 Nov;138:59-67. doi: 10.1016/j.toxicon.2017.08.013. Epub 2017 Aug 12. PMID: 28811247.

 

2.      José Alejandro GA, Juan M, Luis CB, Fátima Pamela SM, Ivonne B, Diana Laura PT, Ashly M. Envenomation by the Indian ornamental tarantula (Poecilotheria regalis): A case report on treatment with Latrodectus mactans antivenom. Toxicon. 2024 Aug 28;247:107842. doi: 10.1016/j.toxicon.2024.107842. Epub 2024 Jul 1. PMID: 38960287.

 

3.      Richards NJ, Alqallaf A, Mitchell RD, Parnell A, Haidar HB, Almeida JR, Williams J, Vijayakumar P, Balogun A, Matsakas A, Trim SA, Patel K, Vaiyapuri S. Indian Ornamental Tarantula (Poecilotheria regalis) Venom Affects Myoblast Function and Causes Skeletal Muscle Damage. Cells. 2023 Aug 15;12(16):2074. doi: 10.3390/cells12162074. PMID: 37626884; PMCID: PMC10453882.

 

4.      Ramesh R, Kanagasingam A, Anushanth U, Gunasinghe A, Suganthan N. A Case Report on Generalised Muscle Spasms After Ornamental Tarantula Bites That Responded Well to Intravenous Calcium Gluconate Treatment. Cureus. 2023 Aug 7;15(8):e43074. doi: 10.7759/cureus.43074. PMID: 37692640; PMCID: PMC10483889.

 

Edited by Yu-Jang Su Dec 3, 2024.

 

MDMA (3,4-methylenedioxymethamphetamine) Toxicity

 

Substance:

MDMA (3,4-methylenedioxymethamphetamine), commonly known as Ecstasy, is a derivative of amphetamine and classified as a Schedule II drug. It stimulates the sympathetic nervous system and provides euphoria similar to cocaine and amphetamine [1, 2, 3].

 

Common Name:

Ecstasy, Molly, Adam, Eve, "Happy Pill," and "E."搖頭丸

 

Involving System:

 

Central Nervous System (CNS): altered mental status, seizure, coma. [4]

Cardiovascular System: tachycardia, hypertension, shock [1, 2, 3, 5, 6].

Renal System: acute kidney injury, hyponatremia [2, 3, 4, 5, 6, 7]

Muscular System: rhabdomyolysis [4, 8] 

 

Presentation:

 

Physiological effects: Anxiety, agitation, hyperthermia, tachycardia, sweating, hypertension, hyponatremia, rhabdomyolysis, acute kidney injury, hepatotoxicity, coagulopathy, seizures, electrolyte imbalances, and shock. [3, 5, 8]

 

Complications: Approximately 30% of cases may present with rhabdomyolysis, and 13% may progress to acute kidney injury. [8]

 

Additional risks include brain edema, intracranial hemorrhage, pulmonary edema, and multiple organ failure. [1, 6]

 

Chronic use effects: Long-term use may result in memory impairment, serotonin neuron damage, mood swings, insomnia, appetite loss, and addiction potential. [9, 10]

 

Antidote and Treatment: [11, 12, and 13]

 

Supportive care is the primary treatment, as there is no specific antidote for MDMA.

Gastrointestinal decontamination with gastric lavage within one hour, activated charcoal administration.

Airway management and oxygen support, rehydration, electrolyte balancing.

Sedation with benzodiazepines (e.g., diazepam at 0.1–0.3 mg/kg orally or intravenously) for agitation.

Seizure management using diazepam.

Hyponatremia management via fluid restriction or hypertonic saline for severe cases.

Metabolic acidosis correction with sodium bicarbonate.

Severe hypertension treatment with labetalol if indicated.

Hyperthermia management with dantrolene if body temperature exceeds 39°C, along with other cooling measures.

Mechanical ventilation may be required for patients with altered consciousness, along with treatment for potential multiple organ failure.

 

Disposition:

Close monitoring is essential, especially for patients with complications like rhabdomyolysis, renal injury, or serotonin syndrome. Admission to the ICU is recommended in severe cases. [20]

 

References

 

 

1. Kahn DE, Ferraro N, Benveniste RJ. 3 cases of primary intracranial hemorrhage associated with  "Molly", a purified form of 3,4-methylenedioxymethamphetamine (MDMA). J Neurol Sci. 2012 ;323(1-2):257-60.

 

2. Diffley M, Armenian P, Gerona R, Reinhartz O, Avasarala K. Catecholaminergic polymorphic ventricular tachycardia found in an adolescent after a methylenedioxymethamphetamine and marijuana-induced cardiac arrest. Crit Care Med. 2012 ;40(7):2223-6.

 

3.Grunau BE, Wiens MO, Brubacher JR. Dantrolene in the treatment of MDMA-related hyperpyrexia: a systematic review. CJEM. 2010 ;12(5):435-42.

 

4.Devlin RJ, Henry JA. Clinical review: Major consequences of illicit drug consumption. Crit Care. 2008;12(1):202.

 

5.Mohamed WM, Ben Hamida S, Cassel JC, de Vasconcelos AP, Jones BC. MDMA: interactions with other psychoactive drugs. Pharmacol Biochem Behav. 2011 ;99(4):759-74.

 

6.Kaye S, Darke S, Duflou J. Methylenedioxymethamphetamine (MDMA)-related fatalities in Australia: demographics, circumstances, toxicology and major organ pathology. Drug Alcohol Depend. 2009 ;104(3):254-61.

 

7.Salathe C, Blanc AL, Tagan D. SIADH and water intoxication related to ecstasy. BMJ Case Rep. 2018 Aug 29;2018:bcr2018224731. doi: 10.1136/bcr-2018-224731. PMID: 30158258; PMCID: PMC6119400.

 

8. Yu CH, Huang LC, Su YJ. Poisoning-Induced Acute Kidney Injury: A Review. Medicina (Kaunas). 2024 Aug 12;60(8):1302. doi: 10.3390/medicina60081302. PMID: 39202583; PMCID: PMC11356116.

 

9. McCann UD, Ricaurte GA. Effects of (+/-) 3,4-methylenedioxymethamphetamine (MDMA) on sleep and circadian rhythms. ScientificWorldJournal. 2007 Nov 2;7:231-8. Review.

 

10.Hui T, Guo S. Early onset Parkinson's disease in the cycle of 3,4-methylenedioxymethamphetamine and substance use: a case report. J Med Case Rep. 2023 Sep 23;17(1):405. doi: 10.1186/s13256-023-04147-x. PMID: 37740189; PMCID: PMC10517548.

 

11. Grunau BE, Wiens MO, Greidanus M. Dantrolene for the treatment of MDMA toxicity. CJEM. 2010 ;12(5):457-9.

 

12.Moon J, Cros J.  Role of dantrolene in the management of the acute toxic effects of Ecstasy (MDMA). Br J Anaesth. 2007 ;99(1):146.

 

13.Hall AP, Henry JA. Acute toxic effects of 'Ecstasy' (MDMA) and related compounds: overview of pathophysiology and clinical management. Br J Anaesth. 2006 Jun;96(6):678-85. doi: 10.1093/bja/ael078. Epub 2006 Apr 4. PMID: 16595612.

 

Edited by Yu-Jang Su, Nov 5, 2024