Swarming hornet attacks: shock and acute kidney injury--a large case series from Vietnam.

BACKGROUND: Social hornets attack victims in swarms in Asia, Africa and the Middle East. The venom consists of multiple proteins with myotoxin, haemotoxin, vasodilatory and anticoagulant effects. METHODS: We reviewed the records of 65 patients at Cho Ray Hospital (Ho Chi Minh City, Vietnam) attacked by swarms of the lesser banded hornet, Vespa affinis. Patients were divided into four groups. Groups A and B presented within 3 days of attack and C and D after 3 days with 50 stings, respectively. RESULTS: Varying degrees of acute kidney injury (AKI) were seen in 38 (58.5%) patients in all groups. Twenty nine required renal replacement therapy. AKI was likely to be myoglobin and toxin induced with a clinical course consistent with acute tubular injury. The prognosis for renal recovery is excellent in those who survive. Seven patients (one from Group A and six from Group B) developed non-anaphylactic shock which led to four deaths. The predominant finding in Groups C and D who sought delayed tertiary care is renal failure. CONCLUSIONS: This cases which illustrate the varied effects of hornet venom and the need to be vigilant for shock within the first 2 days and persistent AKI beyond 3 days of attack.

Ichthyotoxic ARF after fish gallbladder ingestion: a large case series from Vietnam.

Fish gallbladders are consumed in rural areas of Asia as a traditional medicine to improve symptoms of arthritis, decreased visual acuity, and impotence. Consumption of large amounts of this traditional medicine can result in systemic toxicities; in particular, acute renal failure. We reviewed records of all admissions to Cho Ray Hospital (Ho Chi Minh City, Vietnam) between January 1995 and December 2000 after this ingestion. Clinical courses and outcomes were similar in 16 of 17 patients. Within hours, patients experienced profuse vomiting (n = 16) and diarrhea (n = 15). All developed acute renal failure, with a mean serum creatinine concentration of 14.7 +/- 3.9 mg/dL (1,299.5 +/- 344.8 micromol/L). Four patients administered intravenous fluid (IVF) developed extracellular fluid volume overload, as did 1 patient not administered IVF. Time to peak creatinine concentration was 8.6 +/- 3.0 days, which was accompanied by decreased urine volume (174.7 +/- 161.6 mL/24 h). Blood pressure remained normal, with a mean arterial pressure of 91 +/- 12 mm Hg. Twelve patients required renal replacement therapy. A mean of 1.9 +/- 1.1 hemodialysis sessions was performed per patient. Sixteen patients recovered renal function; 1 patient died of fulminant hepatic failure. Kidney biopsies showed features of acute tubular injury. Acute renal failure after fish gallbladder ingestion is characterized by a failure to respond to IVF, an 8.6-day interval to peak creatinine level, frequent need for dialysis therapy, and findings on renal biopsy consistent with acute tubular necrosis. Acute renal failure after fish gallbladder ingestion has an excellent prognosis. However, death from fulminant hepatic failure can occur.