Wasp stings are a common day occurrence in tropical countries. Their venom contains a wide array of amines, peptides and enzymes, consisting of low molecular weight compounds such as serotonin, histamine, acetylcholine and several kinins that mediate direct toxic effects. Enzymes such as hyaluronidase and phospholipases allow the venom to spread. Generally, these stings cause local reactions that include immediate pain, wheal and flare reaction, which resolve within a few hours. Rarely, these reactions can cause systemic manifestations, organ dysfunction and even death. We describe one such extremely unusual presentation in which a wasp sting was associated with type 1 (distal) renal tabular acidosis (RTA).
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