Table 2.

Key points of massive envenomation by killer bees (more than 1 sting/kg)

	Systemic reaction
	Immediate	Delayed
Diagnosis	• Anaphylaxis:	• Rhabdomyolysis
	⇒ Involvement of the skin-mucosal tissue,	• Acute renal failure
	⇒ Respiratory compromise,
	⇒ Reduced BP or associated symptoms,
	⇒ Persistent gastrointestinal symptoms.
Treatment recommended by learned societies	• Epinephrine IM, 10 µg/kg, repeated every 10–15 minutes until there is a response,	• Isotonic saline hydration.
	• Vascular filling,
	• Oxygen therapy if needed.