SINGAPORE: A 60-year-old man who was attacked by a swarm of hornets while cycling past a temple along a park connector in Sembawang died three days later in hospital.
The toxin from the insect bites affected his vital organs, beginning with the liver and kidneys, and the increased acidity in his blood caused further organs to fail, a coroner's court heard on Tuesday (Mar 5).
Mr Ronnie Ang's final cause of death was multi-organ failure following insect attacks and ischaemic heart disease, the court heard on the first day of the inquiry into Mr Ang's death.
WHAT HAPPENED
The court heard that Mr Ang was cycling along a park connector in Sembawang on the late morning of Jul 4, 2022.
As he passed the Sembawang God of Wealth temple sometime between 11.45am and 11.55am, he was stung multiple times by a swarm of hornets while riding his bicycle.
He called his wife, Madam Oh, and told her that he had been chased and stung by a swarm of hornets near the temple.
Mdm Oh intially told him to go home and said she would take him to the doctor before calling him again several minutes later and asking him where he was exactly.
Mr Ang said he was at the park connector in front of Block 467A Admirality Drive, which is about seven minutes away from the temple by bicycle.
He said he was unable to cycle home as he was giddy and breathless and had a sore throat.
Mdm Oh told her husband to wait for her and called for an ambulance before heading down.
When she found her husband, she saw multiple sting marks on him. He had removed his shirt and said he was thirsty and his throat had swelled up.
He repeatedly said he was very uncomfortable and was breathless.
Mdm Oh took a photo of her husband's back and sent it to her family group chat consisting of her daughters.
Mr Ang was taken to KTPH and warded in the Medical Intensive Care Unit (MICU) on the morning of Jul 5, 2022.
No clinical signs of an allergic reaction were noted but he was treated for any possible allergic reaction.
He was treated for multi-organ failure due to stings from insects which were unidentified at the point in time.
He developed acute liver failure and his kidneys also failed, and he was placed on continuous dialysis.
However, his condition deteriorated and he died on the morning of Jul 7, 2022.
An autopsy showed no external or internal evidence of anaphylaxis. Lesions found on his body were consistent with insect stings, but no stingers were found left in the body.
Mr Ang, who had a history of hypertension, was found to have an enlarged heart.
The investigating officer on the case said the police did not suspect foul play and said this was likely a case of misadventure.
Investigations uncovered a hornet nest from the branches of a tree along the park connector.
DOCTOR'S EVIDENCE
Dr Lim Chiow Teen, a senior consultant at KTPH who was in charge when Mr Ang was warded in MICU, gave evidence on the stand and described how Mr Ang's condition deteriorated.
She explained that blood and other laboratory tests that were done by her colleagues in the emergency department showed a worsening trend, so she and her colleagues decided to ward Mr Ang in the MICU.
Dr Lim said she felt Mr Ang was a priority two case according to KTPH's criteria for MICU - with priority one for patients who need immediate life-sustaining treatment.
She explained that Mr Ang's liver function and kidney function tests were worsening and he could potentially require dialysis at the time of her assessment.
Dr Lim said the hospital knew Mr Ang had been stung by insects but did not know what kind.
She added that there is no specific antidote for hornet stings or insect stings and no general antidote to counter the venom of insects generally.
Asked by the state counsel if there was any assessment on how the insect stings caused the organ failure, Dr Lim said this is 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," she said.
She explained that the increased acidity in the blood suppressed the heart function and led to failure of other organs.
Mr Ang's daughter and widow asked several questions of Dr Lim, including why toxicology tests were not done at the emergency department and why tetanus shots were not given.
Dr Lim said she was not from the emergency department but said she did not think there was any specific toxicology test available for hornet stings.
She added that tetanus shots are not part of the hospital's protocol for insect stings.
Mdm Oh said she worked at a clinic and her doctor would give tetanus shots for insect bites, questioning why the hospital did not.
The coroner then told her that she would need her doctor to provide evidence backing up her statement, and that regardless, Dr Lim had testified that it was not in the hospital's protocol.
The hearing was attended by lawyers from Lee & Lee, representing a Khoo Teck Puat Hospital (KTPH) doctor who attended to Mr Ang, as well as lawyers from Rajah & Tann, representing NParks.
The inquiry continues.
CNA has contacted NParks for more information on the hornets in the area.
https://www.channelnewsasia.com/sin...-park-connector-cycling-nparks-temple-4171916
