How to identify a coral snake. What are the symptoms of a coral snake bite. When to seek medical attention for a coral snake bite. How is a coral snake bite treated. What is the prognosis for coral snake envenomation. How to prevent coral snake bites.

Identifying Coral Snakes: The Crucial “Red Touch Yellow” Rule

The age-old rhyme “Red touch yellow, kills a fellow; red touch black, venom lack” serves as a vital mnemonic device for distinguishing venomous coral snakes from their harmless lookalikes. This colorful adage refers to the distinctive banding pattern found on coral snakes, which typically consists of red, black, and yellow (or white) rings encircling their bodies.

However, it’s important to note that this rule applies primarily to the native coral snake species found in the United States. Non-native species may exhibit different color patterns, making identification more challenging for the untrained eye.

U.S. Coral Snake Species

• Eastern coral snake (Micrurus fulvius): Found in Florida and the southeastern United States
• Texas coral snake (Micrurus tener): Found in Texas and northwestern Mexico
• Arizona or Sonoran coral snake (Micruroides euryxanthus): Found in the southeastern United States and Sonora, Mexico

While the “red touch yellow” rule is a helpful guideline, it’s crucial to exercise caution around any snake with similar coloration. When in doubt, it’s always best to maintain a safe distance and seek expert assistance for proper identification.

Coral Snake Behavior and Bite Characteristics

Coral snakes are members of the Elapidae family, which includes cobras. Despite their potent venom, coral snakes are generally reclusive creatures that prefer to avoid confrontation. They rarely bite unless provoked or threatened, which contributes to the relatively low incidence of coral snake bites compared to other venomous snake species.

In fact, coral snake bites account for only about 2% of snake bites reported to U.S. Poison Centers annually. This low percentage is partly due to their shy nature and partly because of their unique bite mechanism.

Bite Mechanism and Venom Delivery

Unlike pit vipers such as rattlesnakes, coral snakes have small, fixed fangs. When they bite, they tend to latch onto their prey and “chew” for a few seconds to deliver their venom effectively. This biting behavior can result in bite marks that are easily missed, as they often show no significant local tissue damage, obvious injury, or immediate pain.

The lack of immediate, visible symptoms can lead to a dangerous false sense of security. It’s crucial to seek medical attention immediately if you suspect a coral snake bite, even if there are no apparent signs of envenomation.

The Deadly Neurotoxin: Understanding Coral Snake Venom

While all coral snake bites should be taken seriously, those from the Eastern coral snake are generally considered the most severe. The venom of this species contains potent neurotoxins that can cause severe illness or death if left untreated.

How does coral snake venom work? The neurotoxins in coral snake venom target a crucial neurotransmitter called acetylcholine. This neurotransmitter plays a vital role in muscle activation throughout the body. When the venom blocks acetylcholine, it can lead to a cascade of serious symptoms, including weakness, paralysis, and potentially complete respiratory failure in severe cases.

Delayed Onset of Symptoms

One of the most insidious aspects of coral snake envenomation is the delayed onset of symptoms. Effects may not appear for up to 13 hours after the bite, but once they develop, they can progress rapidly. This delay underscores the importance of seeking immediate medical attention, even if the bite initially seems harmless.

Recognizing Coral Snake Bite Symptoms

Given the potential severity of coral snake envenomation, it’s crucial to be aware of the symptoms that may develop. These can include:

• Nausea and vomiting
• Paresthesias (abnormal sensations)
• Slurred speech
• Double vision
• Ptosis (drooping eyelids)
• Muscle twitching
• Progressive weakness
• Paralysis

The most serious complication of coral snake envenomation is respiratory failure resulting from neuromuscular weakness. This highlights the critical need for prompt medical intervention and close monitoring of respiratory function in bite victims.

Emergency Response and Medical Treatment for Coral Snake Bites

Given the potentially life-threatening nature of coral snake bites, all suspected envenomations should be treated as medical emergencies. What should you do if you or someone else is bitten by a coral snake?

1. Call 911 or your local emergency number immediately.
2. Keep the victim calm and still to slow the spread of venom.
3. Remove any constricting items (e.g., jewelry, tight clothing) from the affected limb.
4. Position the bite site below the heart if possible.
5. Do not attempt to suck out the venom or apply a tourniquet.
6. If available, contact Poison Control (1-800-222-1222) for additional guidance.

All individuals with suspected coral snake envenomation should be transported to a hospital immediately and observed for at least 24 hours, even if they initially appear unaffected.

Antivenom Treatment

The traditional treatment for coral snake envenomation has been the North American Coral Snake Antivenin, a horse-derived IgG antibody antivenom produced by Wyeth Pharmaceuticals (now a subsidiary of Pfizer, Inc.). However, production of this antivenom ceased in 2006, creating challenges in treatment availability.

The remaining available antivenom has passed the manufacturer-assigned expiration date of 2008. However, the FDA continues to provide information on expiration date extensions based on stability data evaluations. Due to limited supply, healthcare providers must work closely with regional Poison Control Centers to locate available antivenom when needed.

Supportive Care and Alternative Treatments

In cases where antivenom is unavailable or deemed unsuitable, management focuses on supportive care. This primarily involves airway management and mechanical ventilation if respiratory failure occurs.

Some alternative treatments have shown potential benefits for certain coral snake bites. For instance, the anticholinesterase drug neostigmine has demonstrated some efficacy, although data on its use is limited and inconsistent. In all cases, close collaboration among healthcare providers, Poison Control Centers, and toxicologists is essential to determine the optimal care plan for each patient.

Prognosis and Long-Term Effects of Coral Snake Bites

The prognosis for coral snake envenomation largely depends on the speed and quality of medical intervention. With prompt treatment, including appropriate antivenom administration when available, most patients recover fully without long-term complications.

However, severe cases that progress to respiratory failure or other systemic complications may have more prolonged recovery periods. In rare instances, particularly if treatment is delayed, coral snake bites can be fatal.

It’s important to note that the severity of envenomation can vary significantly between species and individual snakes. Bites from the Arizona/Sonoran and Texas coral snakes are generally not associated with serious side effects or death, unlike those from the Eastern coral snake.

Long-Term Monitoring

Following a coral snake bite, patients typically require close monitoring for at least 24 hours, even if they initially appear asymptomatic. This observation period is crucial due to the potential delayed onset of symptoms.

After discharge, patients may need follow-up appointments to ensure complete recovery and to monitor for any delayed complications. In most cases, however, patients who receive prompt and appropriate treatment can expect a full recovery without lasting effects.

Preventing Coral Snake Encounters and Bites

While coral snake bites are relatively rare, prevention is always preferable to treatment. Here are some essential tips to minimize the risk of encountering coral snakes and avoiding bites:

• Learn to identify coral snakes and their habitats in your area.
• Wear protective footwear when walking in areas where coral snakes may be present.
• Use a flashlight when walking in dimly lit areas, especially at night.
• Avoid reaching into brush, leaf litter, or dark spaces without first checking for snakes.
• Keep your yard well-maintained and free of debris that could attract snakes.
• If you encounter a coral snake, maintain a safe distance and allow it to move away.
• Never attempt to handle or capture a coral snake, even if you believe it to be dead.
• Educate children about the dangers of coral snakes and the importance of avoiding them.

By following these precautions and respecting the natural habitat of coral snakes, you can significantly reduce the risk of dangerous encounters.

The Future of Coral Snake Bite Treatment: Research and Developments

As the supply of traditional coral snake antivenom continues to dwindle, researchers and medical professionals are exploring new avenues for treatment. What advancements are being made in coral snake bite management?

New Antivenom Development

Several research initiatives are underway to develop new, more effective antivenoms for coral snake bites. These efforts include:

• Exploring recombinant DNA technology to produce safer, more targeted antivenoms
• Investigating the potential of small molecule inhibitors to neutralize coral snake venom components
• Studying the venom profiles of different coral snake species to create more specific treatments

Alternative Treatment Approaches

In addition to antivenom development, researchers are investigating alternative treatment strategies, such as:

• Neuroprotective agents to mitigate the effects of neurotoxins
• Advanced life support techniques to improve outcomes in severe envenomation cases
• Novel drug delivery methods to enhance the efficacy of existing treatments

These ongoing research efforts hold promise for improving the treatment of coral snake bites in the future, potentially reducing the reliance on traditional antivenoms and improving patient outcomes.

Public Health Initiatives

Alongside medical advancements, public health initiatives play a crucial role in reducing the impact of coral snake bites. These efforts include:

• Improved education and awareness programs in areas where coral snakes are prevalent
• Enhanced training for healthcare providers in the identification and management of coral snake bites
• Development of more effective snakebite reporting systems to better understand the epidemiology of coral snake envenomations

By combining medical research with public health strategies, the medical community aims to reduce the incidence and severity of coral snake bites, ensuring better outcomes for those unfortunate enough to experience these potentially deadly encounters.

Coral Snake Bite Treatment | Poison Control

The Full Story

“Red touch yellow, kills a fellow; red touch black, venom lack.“ Of all the childhood rhymes we’ve grown up learning, this one might be high on the list of ones to remember if you live in coral snake country. If you aren’t familiar with this saying, it refers to distinguishing the venomous coral snake from its nonvenomous look-alikes (e.g., the king snake, shovel-nosed snake, and milk snake). It’s important to note that this general rule doesn’t apply to non-native coral snake species, which might have different patterns. Coral snakes are members of the Elapidae family, which includes cobras. Coral snakes usually have a pattern of red, black, yellow (or white) colored rings that span their bodies. For the purposes of this article, we’ll focus primarily on the three species found in the US, which are:

• Eastern coral snake (Micrurus fulvius) – Found in Florida and the southeastern US
• Texas coral snake (Micrurus tener) – Found in Texas and northwestern Mexico
• Arizona or Sonoran coral snake (Micruroides euryxanthus) – Found in southeastern US, and Sonora, Mexico)

By nature, coral snakes are reclusive and seldom bite unless they’re provoked or threatened. Compared to their pit viper counterparts (e.g., rattlesnakes), coral snake bites are uncommon and represent only about 2% of snake bites reported to US Poison Centers annually. Of the three species in the US, bites by the eastern coral snake tend to be the most severe, while those of the Arizona/Sonoran and Texas coral snakes aren’t generally associated with serious side effects or death. 

Coral snakes have small, fixed fangs, and when they bite they tend to latch onto their prey and “chew” for a few seconds in order to deliver their venom. Compared to other venomous snakes, their bite marks can be easily missed, often showing no significant local tissue damage, obvious injury, or pain. However, the venom of the Eastern coral snake contains very potent neurotoxins that can cause severe illness or death if left untreated. The neurotoxic venom blocks an important neurotransmitter called acetylcholine, which is important for the activation of muscles in the body. Blockade of acetylcholine after envenomation can lead to weakness and paralysis and even complete respiratory failure in severe cases. The effects of the venom are usually delayed (up to 13 hr) but progress rapidly once they develop. Symptoms of a coral snake envenomation can include nausea, vomiting, paresthesias (abnormal sensations), slurred speech, double vision, ptosis (drooping eye), muscle twitching, weakness, and paralysis. The major cause of death from coral snake envenomations is respiratory failure as a result of neuromuscular weakness.

Given the potentially serious outcomes after a coral snake bite, all people with a suspected envenomation should be seen in a hospital immediately and observed for at least 24 hours. The traditional treatment for coral snake envenomation has been a horse-derived IgG antibody antivenom produced by Wyeth Pharmaceuticals (now a subsidiary of Pfizer, Inc.) called the North American Coral Snake Antivenin. However, the manufacturer stopped production in 2006. The remaining available antivenom has passed the manufacturer-assigned expiration date of 2008, but FDA continues to provide information on expiration date extensions based evaluation of stability data. Because having a supply of the antivenom is uncommon in most hospitals, healthcare providers need to work with their regional Poison Control Center to locate a source of supply. If the antivenom is available, if and when to start is decided on a case-by-case basis after careful risk/benefit assessment as antivenom administration is not without dangers. If the antivenom is unavailable, management of the patient is focused on supportive care, which includes airway management with mechanical ventilation. There are other treatment options that have been shown to possibly provide benefit for certain coral snake bites, like the anticholinesterase drug neostigmine. However, data on its efficacy is limited and inconsistent. In all cases, discussion among the healthcare providers, Poison Control Centers, and toxicologists is key to providing optimal care for each patient.

If you or someone you know has been bitten by a coral snake, seek medical attention by calling 911 or Poison Control (1-800-222-1222), or use the webPOISONCONTROL^{® online tool for guidance.}

Kristina Yee, PharmD
Certified Specialist in Poison Information

Poisoned?

Call


1-800-222-1222


or

HELP ME online

Prevention Tips

• Coral snakes aren’t usually aggressive unless they feel threatened or are provoked. If you come across one, leave it alone!
• If someone has been bitten by a coral snake, seek medical evaluation immediately. Do NOT wrap the area in a tourniquet, cut the wound, or attempt to “suck the venom out.” None of these are helpful and can potentially make things worse.

This Really Happened

Case 1. A 9-year-old boy was bitten on the right index finger after a coral snake was thrown at him. He reported local and radiating pain at the bite site as well as abdominal pain. One hour after the incident, he was taken to a hospital and received 5 vials of antivenom. He was observed in the ICU and only developed mild local swelling. He was discharged after 3 days in the hospital.

Case 2. A 15-year-old girl was bitten on her arm by an exotic coral snake. She was taken to a hospital and observed in the ICU. She was not treated with antivenom due to its unavailability. Her only reported symptoms were vomiting and swelling, and she was discharged after 3 days in the hospital.

Case 3. A 6-year-old boy was bitten while catching a coral snake. He developed anaphylaxis during antivenom administration. Nine hours after the bite he had drooling and difficulty swallowing and required mechanical ventilation for 8 days. He was discharged after 16 days in the hospital.

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For More Information

Expiration date extension for North American coral snake antivenin (Micurus fulvius) (equine origin) lot L67530 through January 32, 2020. Silver Spring (MD): US Food and Drug Administration; 2019 Feb 1 [cited 2020 Aug 31].

Sartore J. Eastern coral snake [photo].Washington: National Geographic Society [cited 2020 Aug 31].

References

Corbett B, Clark RF. North American snake envenomation. Emerg Med Clin North Am. 2017 May;35(2):339-54.

Expiration date extension for North American coral snake antivenin (Micurus fulvius) (equine origin) lot L67530 through January 32, 2020. Silver Spring (MD): US Food and Drug Administration; 2019 Feb 1 [cited 2020 Aug 31].

Hessel MM, Sauerberg N, McAninch SA. Coral snake toxicity. Treasure Island (FL): StatPearls Publishing; 2020 Apr 23 [cited 2020 Aug 31].

Hoffman, RS, Howland, MA, Lewin, NA, Nelson, LS, Goldfrank, LR, editors. Goldfrank’s toxicologic emergencies. 10th ed. New York: McGraw Hill; c2015. Chapter 122, Native (US) venomous snakes and lizards.

McAninch SA, Morrissey RP, Rosen P, Meyer TA, Hessel MM, Vohra MH. Snake Eyes: Coral Snake Neurotoxicity Associated With Ocular Absorption of Venom and Successful Treatment With Exotic Antivenom. J Emerg Med. 2019 May;56(5):519-522.

Pawar DK, Singh H. Elapid snake bite. Br J Anaesth. 1987 Mar;59(3):385-7. 

Peterson ME. Snake bite: coral snakes. Clin Tech Small Anim Pract. 2006 Nov;21(4):183-6. 

Sánchez EE, Lopez-Johnston JC, Rodríguez-Acosta A, Pérez JC. Neutralization of two North American coral snake venoms with United States and Mexican antivenoms. Toxicon. 2008 Feb;51(2):297-303.

Sasaki J, Khalil PA, Chegondi M, Brzezinski A, Meyer KG, et al. Coral snake bites and envenomation in children: a case series. Pediatr Emerg Care. 2014 Apr;30(4):262-5.

Wood A, Schauben J, Thundiyil J, Kunisaki T, Sollee D, et al. Review of eastern coral snake (Micrurus fulvius fulvius) exposures managed by the Florida Poison Information Center Network: 1998-2010. Clin Toxicol (Phila). 2013 Sep-Oct;51(8):783-8.

Poisoned?

Call


1-800-222-1222


or

HELP ME online

Prevention Tips

• Coral snakes aren’t usually aggressive unless they feel threatened or are provoked. If you come across one, leave it alone!
• If someone has been bitten by a coral snake, seek medical evaluation immediately. Do NOT wrap the area in a tourniquet, cut the wound, or attempt to “suck the venom out.” None of these are helpful and can potentially make things worse.

This Really Happened

Case 1. A 9-year-old boy was bitten on the right index finger after a coral snake was thrown at him. He reported local and radiating pain at the bite site as well as abdominal pain. One hour after the incident, he was taken to a hospital and received 5 vials of antivenom. He was observed in the ICU and only developed mild local swelling. He was discharged after 3 days in the hospital.

Case 2. A 15-year-old girl was bitten on her arm by an exotic coral snake. She was taken to a hospital and observed in the ICU. She was not treated with antivenom due to its unavailability. Her only reported symptoms were vomiting and swelling, and she was discharged after 3 days in the hospital.

Case 3. A 6-year-old boy was bitten while catching a coral snake. He developed anaphylaxis during antivenom administration. Nine hours after the bite he had drooling and difficulty swallowing and required mechanical ventilation for 8 days. He was discharged after 16 days in the hospital.

Coral Snake – Poison Center Tampa

FAQ’s About Coral Snakes

About Eastern Coral Snakes

How many bites occur each year?
An average of 47 bites to humans are reported to Florida poison centers each year.

Identification and Classification of Coral Snakes

How can the eastern coral snake be identified?
Multi-colored rings encircle its body with red, black and yellow bands. Every other band is yellow. Red bands touch yellow bands. The nose is black. The pupils are round.
Teeth are small (see bite pattern diagram). It does NOT have large fangs like pit vipers. The head is the same width as the rest of the body and does NOT have a large head like pit vipers. The average size is about two feet long.

Where are coral snakes found?
They are only found in the southeastern USA (see map). Their preferred habitat is pine/oak scrub, but they have been sighted in suburbs.

What is the Latin name and classification for eastern coral snakes?
Micrurus fulvius in Elapidae family.

About coral snakebites: What happens when a person is bitten?

About coral snakebites:

For emergency assistance, please call 911 for EMS transport to your closest hospital. To notify experts of your envenomation, please contact your regional poison center at 1-800-222-1222.

About snakebite toxicity: What happens when a person is bitten?
The neurotoxic effects of the coral snake venom are manifested by muscle weakness, difficulty speaking, difficulty swallowing, difficulty breathing, unable to move eyelids (ptosis), blurred vision (diplopia), tongue fasciculations (twitching), decreased oxygen saturation, paralysis, and potential respiratory arrest. A patient may face weeks of ventilator support with subsequent pneumonia, tracheotomy and multi-system failure. Long term rehabilitation may be needed for neuromuscular damage. Prophylactic use of antivenom, which has long been the recommendation of poison centers, has been effective in preventing these signs and symptoms. Case reports of patients in which antivenom was delayed show that symptoms can progress to paralysis over a 12-18 hours period. In the last 40 years, there has been one fatality reported when a person failed to seek medical treatment after a bite.

What does the bitten area (bite site) look like?
The coral snake may deliver venom by hanging on to chew but can also deliver venom in one quick strike. Blood at the puncture site signals that the skin has been broken and a possible envenomation has occurred. The mild signs around the bitten area and the delayed onset of symptoms (up to 18 hours) often lead people to believe that no damage has been done.

About Treatment of Coral Snakebites

About medical treatment: How effective is the antivenin treatment?
Before the antivenin was developed in 1967, the fatality rate was reported as high as 10-20%. Since then, the recommended treatment involves giving antivenin as soon as possible after a bite. Call the poison center for advice on each coral snakebite.

First Aid

Go to emergency department immediately. Do not apply tourniquets. Do not apply ice. Do not cut the skin and suck the bite.

Additional photos of Florida snakes:

University of Florida – IFAS

Florida Fish and Wildlife Conservation Commission

Coral Snake’s Unique Poison: How It Works

Blue Coral Snake can kill not only frogs and rodents, but also other venomous snakes. For these purposes, evolution has provided him with a unique toxin that turns the last hours of the victim’s life into a living hell.

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We are accustomed to the fact that in the wild snakes usually feed on rodents and other small and harmless animals. However, the beautiful and deadly blue coral snake preys on fast and venomous snakes. Such a prey must not only be caught up, but also immobilized, and for this purpose the reptile uses a special poison that turns the last seconds of the prey’s life into real torture.

Do not self-medicate! In our articles, we collect the latest scientific data and the opinions of authoritative health experts. But remember: only a doctor can diagnose and prescribe treatment.

In order not to get lost and always be in touch, read us on Yandex.Zen and don’t forget to subscribe to us on Telegram, VKontakte and Odnoklassniki!

Unique Snake Venom

A bright color in nature often symbolizes the creature’s danger, and just a glance at this snake immediately tells the enemy who he is dealing with. Found in southeastern Asia, blue coral snakes, or as scientists call them, two-banded ferruginous snakes (Calliophis bivirgatus), are distinguished by a bright red, neon-lit head and blue patterns throughout – it is not for nothing that they are included in the genus “Decorated Asps”. In an article published in the journal Toxins, researchers from the University of Queensland in Australia describe the unique properties of snake venom, which, when released into the bloodstream, provides the victim with an extensive shock to the entire physiological system.

What happens to the victim after being bitten

Almost immediately after being bitten, the victim goes into a catatonic state. The poison causes the entire nervous network of the body to chaotically strain the muscles, as a result of which the victim beats in spasmodic convulsions. Paralyzed and helpless, she eventually becomes the prey of a predator. Although this sounds very ominous, evolution had its own reasons for this: coral asps prey on other poisonous snakes, which have exceptional reaction, flexibility and an impressive arsenal of self-defense. A special venom is produced and stored in the gland, which makes up a full quarter of the snake’s total body.

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Why scientists are interested in the toxin

Scientists have already seen similar toxins in nature, but they have never been found in snakes, let alone other vertebrate species. Such poisons are characteristic primarily of scorpions and spiders. Conus, a predatory gastropod, injects a similar toxin into the fish, which instantly paralyzes them with spasmodically tensed muscles, similar to tetanus. The venom of the two-striped glandular snake has the same effect, and scientists say it is a good example of convergent evolution (the case when the same trait appears in several species of living creatures independently of each other). Researchers refer to its effect as spasmodic paralysis, while the venoms of other snakes cause peripheral paralysis. Interaction with poison blocks the ability of nerves to “turn off” sodium channels, which results in continuous signal transmission and, as a result, constant tension in muscle fibers.

Ironically, the dreaded toxin can be used for medical purposes. Currently, experts are developing drugs based on it that will act as an analgesic.

PALITOXIN AND CORAL POISONING | Mürgistusteabekeskus

Palitoxin is a toxin found in coral that can also be found in tropical fish, sea anemones and crabs in the Caribbean, Indian and Pacific Oceans and off the coast of Africa. However, the main sources of this toxin are corals of the family Palythoa and mostly soft corals ( Palythoa spp., Zoanthus spp. ) and dinoflagellates ( Ostreopsis spp. ).

The toxin can also be found in corals grown in home marine aquaria. Palitoxin is an activator of sodium-potassium channels in the body and is a potent vasoconstrictor.

The toxin is also absorbed through damaged skin and mucous membranes during coral handling. Poisoning can also occur when the toxin is inhaled if the corals have been cooked, crushed, or otherwise processed. It can also happen when cleaning the aquarium, especially during coral blooms. In no case should such corals be brushed. Coral poisoning can happen not only to people, but also to pets.

Symptoms of coral poisoning usually begin within 30-60 minutes of first contact, rarely within 2 hours. However, serious poisoning requiring immediate attention can occur even within 15 minutes of first exposure to the toxin. All people exposed to palytoxin should be monitored in a hospital, and full recovery may take longer.

The most common symptoms are cough, metallic taste in the mouth, dry mouth, gastrointestinal irritation, headache, dizziness and tingling in the hands. In more severe cases, palpitations, low blood pressure, slow heart rate, cyanosis, and muscle cramps are added.

There is no laboratory method for determining the content of palytoxin. The diagnosis of human poisoning is usually based on the information collected (the person knows they have eaten fish that may contain palytoxin, or cleaned a marine aquarium containing palytoxin-producing corals) but on a description of the health complaints that have occurred. There is no antidote for treatment, but treatment is supportive and symptomatic.

As a first aid for poisoning when cleaning the aquarium, leave the room as soon as possible and ventilate it thoroughly before returning. To date, there is no single well-proven method for cleaning surfaces, but a mildly acidic cleaner is often used.