Man died after being stung by hornets at Sembawang park connector, KTPH doctor says tetanus shots not part of hospital's protocol for insect stings

The incident took place as the man was cycling past the Sembawang God of Wealth temple, where investigations later found a hornet nest in a tree.

God of Wealth temple in Sembawang (left), Asian hornet (right): Photos: Google Street View, Getty Images
God of Wealth temple in Sembawang (left), Asian hornet (right): Photos: Google Street View, Getty Images

SINGAPORE — A cycling trip along a park connecter in Sembawang turned deadly for a 60-year-old man after he was attacked by a swarm of hornets. Although Ronnie Ang was admitted to the hospital after the attack, he died three days later as the toxin from the insect bites affected his vital organs, local media CNA reported.

The toxin affected his liver and kidneys first, and the increased acidity in his blood caused more of his organs to fail, the coroner’s court heard during the first day of the inquiry into Ang’s death on Tuesday (5 March).

The final cause of death was multi-organ failure following insect attacks and ischaemic heart disease, CNA reported.

What happened after he was stung by hornets?

The court heard that Ang had cycled past the Sembawang God of Wealth temple on 4 July 2022 just before noon when he was stung multiple times by a swarm of hornets.

He then called his wife, only identified as Mdm Oh, and informed her about the attack. Oh had initially asked him to head home first before they headed to the doctor together.

She then called him again several minutes later and asked him for him exact location, which he shared as Block 467A Admiralty Drive. Ang also told her that he could not cycle home, as he was giddy and breathless, and had a sore throat.

After telling her husband that she would come to where he was, Oh called for an ambulance. When she saw Ang, he had removed his shirt and had multiple sting marks on him, CNA reported. Ang told her that he was thirsty, his throat was swollen, repeatedly said that he was very uncomfortable, and was breathless.

Ang was then brought to Khoo Teck Puat Hospital (KPTH). He was warded in the Medical Intensive Care Unit (MICU) the next day, where he was treated for multi-organ failure due to stings from insects that had not been identified at that time.

He later developed acute liver failure and kidney failure, and was placed on continuous dialysis, but his condition soon deteriorated, and he died on 7 July 2022.

CNA reported that the autopsy showed there was no external or internal evidence of anaphylaxis, a severe, life-threatening allergic reaction. No stingers were found in his body, though the lesions on him were consistent with insect stings.

According to CNA's report, Ang did have a history of hypertension and had an enlarged heart.

The police did not suspect foul play, and said this was likely a case of misadventure. Investigations later found that there was a hornet nest on the branches of a tree along the park, CNA reported.

KTPH doctor says hospital did not know what kind of insects Ang had been stung by

According to CNA's report, Oh and Ang's daughter had raised questions in court over the hospital's response.

KTPH senior consultant Dr Lim Chiow Teen, who was in charge during Ang’s stay at the hospital, said tests had shown that Ang’s condition would worsen, hence the decision was made to ward him in the MICU as he could potentially require dialysis.

She shared that the hospital only knew Ang had been stung by insects, but not what type of insect. Lim said that she did not think there was a specific toxicology test available for hornet stings, and that there is no general antidote to counter the venom of insects, as well as no specific antidote for hornet stings or insect stings. She also said that that tetanus shots were not part of the hospital’s protocol for insect stings

According to CNA, Lim was responding to Oh and Ang’s daughter questioning why no toxicology tests were done at the emergency department and tetanus shots were not given.

Ang's wife Oh then said that she worked at a clinic, and the doctor there would give tetanus shots for insect bites.

CNA reported that the coroner then asked Oh to get the doctor in question to provide evidence that backed up her claim, but added that regardless, Lim had testified that it was not in the hospital’s protocol.

How could insect stings cause organ failure

When asked by state counsel if there was any assessment on how insect stings could cause organ failure, Lim said that it was not well understood.

“In Mr Ang’s case, it started off with multiple insect stings followed by a likely toxin effect on his vital organs, starting off with the liver followed by the kidneys, and then increased acidity in the blood and failure of the liver and kidney to continue functioning to provide for normal bodily function,” CNA reported Lim as saying.

Lim said that the increased acidity in the blood suppressed Ang's heart function, leading to failure of other organs.

The inquiry is ongoing.

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