What are the key characteristics of coral snakes. How to identify a coral snake bite. What are the symptoms of coral snake envenomation. How is a coral snake bite treated. Why is immediate medical attention crucial for coral snake bites. What preventive measures can be taken to avoid coral snake encounters.

Coral Snake Species and Identification

Coral snakes are venomous reptiles belonging to the Elapidae family, which also includes cobras. In the United States, there are three primary species of coral snakes:

• 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

These snakes are known for their distinctive coloration, typically featuring rings of red, black, and yellow (or white) that encircle their bodies. A well-known rhyme often used to distinguish venomous coral snakes from non-venomous lookalikes is: “Red touch yellow, kills a fellow; red touch black, venom lack.” However, it’s crucial to note that this rule doesn’t apply to non-native coral snake species, which may have different color patterns.

Coral Snake Look-alikes

Several non-venomous snakes resemble coral snakes, including:

• King snake
• Shovel-nosed snake
• Milk snake

While these snakes may have similar coloration, their ring patterns differ from those of true coral snakes. Nevertheless, it’s always best to exercise caution and avoid handling any snake you encounter in the wild.

Coral Snake Behavior and Bite Characteristics

Coral snakes are generally reclusive creatures, preferring to avoid confrontation with humans. They rarely bite unless provoked or threatened. This behavior contributes to the relatively low incidence of coral snake bites, which account for only about 2% of snake bites reported to US Poison Centers annually.

When coral snakes do bite, their attack method differs from that of pit vipers like rattlesnakes. Coral snakes have small, fixed fangs and tend to latch onto their prey, “chewing” for a few seconds to deliver their venom. This unique biting mechanism can make coral snake bites challenging to identify, as they often leave little visible evidence of injury.

Bite Characteristics

• Minimal local tissue damage
• Often no obvious injury
• Little to no immediate pain
• Bite marks can be easily missed

Despite the lack of immediate visible symptoms, coral snake bites can be extremely dangerous, particularly those from the Eastern coral snake. The venom contains potent neurotoxins that can cause severe illness or death if left untreated.

Coral Snake Venom and Its Effects

The venom of coral snakes, especially the Eastern coral snake, contains powerful neurotoxins that primarily affect the nervous system. These toxins work by blocking acetylcholine, a crucial neurotransmitter responsible for muscle activation throughout the body.

How does coral snake venom affect the human body? The neurotoxins in the venom interfere with nerve signal transmission, leading to a range of symptoms that can progress from mild to severe. The effects of the venom are usually delayed, sometimes taking up to 13 hours to manifest. However, once symptoms appear, they can progress rapidly.

Symptoms of Coral Snake Envenomation

• Nausea and vomiting
• Paresthesias (abnormal sensations)
• Slurred speech
• Double vision
• Ptosis (drooping eye)
• Muscle twitching
• Weakness
• Paralysis

In severe cases, the venom’s effects can lead to complete respiratory failure, which is the primary cause of death in coral snake envenomations. The neuromuscular weakness caused by the venom can compromise the patient’s ability to breathe, making immediate medical attention crucial.

Immediate Response and Medical Treatment for Coral Snake Bites

Given the potential severity of coral snake bites, it’s imperative to seek immediate medical attention if you suspect you’ve been bitten by a coral snake. All individuals with suspected envenomation should be transported to a hospital without delay and observed for at least 24 hours.

What should you do immediately after a coral snake bite? The first step is to call emergency services (911) or the Poison Control Center (1-800-222-1222) for guidance. You can also use the webPOISONCONTROL® online tool for initial advice. While waiting for professional help, it’s important to keep the affected area immobilized and positioned below the heart to slow the spread of venom.

Traditional 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.

What is the current status of coral snake antivenom? The remaining available antivenom has passed its 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, most hospitals do not stock this antivenom, necessitating coordination with regional Poison Control Centers to locate available supplies when needed.

Alternative Treatment Approaches

In cases where antivenom is unavailable or its use is not deemed appropriate, medical professionals focus on supportive care. This primarily involves airway management, which may include mechanical ventilation if respiratory failure occurs.

Are there other treatment options for coral snake bites? Some studies have shown potential benefits from using anticholinesterase drugs like neostigmine for certain coral snake bites. However, data on its efficacy is limited and inconsistent. In all cases, close collaboration among healthcare providers, Poison Control Centers, and toxicologists is essential to determine the optimal treatment approach for each patient.

Challenges in Coral Snake Bite Treatment

Treating coral snake bites presents several unique challenges for medical professionals. The rarity of these bites, combined with the potentially severe consequences, makes them a complex medical emergency to manage.

Antivenom Availability

One of the primary challenges in treating coral snake bites is the limited availability of antivenom. With production having ceased in 2006, supplies are scarce and often difficult to locate quickly. This scarcity necessitates careful decision-making regarding when and if to administer antivenom, as well as coordination between healthcare facilities to locate available doses.

Delayed Symptom Onset

The delayed onset of symptoms in coral snake envenomation poses another significant challenge. Symptoms may not appear for up to 13 hours after the bite, which can lead to a false sense of security or delayed treatment seeking. This delay makes it crucial for all suspected coral snake bite victims to be observed in a medical setting for at least 24 hours, even if they initially appear unaffected.

Risk-Benefit Analysis of Treatment

Administering antivenom carries its own risks, including potential allergic reactions. Healthcare providers must carefully weigh the potential benefits of antivenom treatment against these risks, especially given the limited supply. This decision-making process often requires consultation with toxicologists and Poison Control Centers to determine the best course of action for each individual case.

Prevention and Safety Measures

While coral snake bites are rare, prevention is always the best approach. Understanding coral snake behavior and habitat preferences can help reduce the risk of encounters.

Habitat Awareness

Coral snakes are typically found in wooded, sandy, or marshy areas of the southeastern United States. They often hide under leaves, logs, or rocks. Being aware of their preferred habitats can help you stay alert in areas where these snakes may be present.

Protective Clothing

When in areas known to have coral snakes, wear appropriate protective clothing. This includes:

• Thick, ankle-high boots
• Long pants
• Thick socks

Safe Outdoor Practices

To minimize the risk of coral snake encounters, follow these safety practices:

• Avoid reaching into hollow logs, rock crevices, or piles of leaves without checking first
• Use a walking stick to probe areas ahead of you when hiking
• Stay on clear, well-maintained paths
• Avoid handling any snake, even if you believe it to be non-venomous

Education and Identification

Educate yourself and others about coral snake identification. While the “red touch yellow” rhyme can be helpful, it’s important to remember that it doesn’t apply to all coral snake species. When in doubt, always assume a snake is venomous and keep your distance.

Research and Future Developments in Coral Snake Bite Treatment

The field of coral snake bite treatment is an area of ongoing research, with scientists and medical professionals working to improve treatment options and outcomes for bite victims.

New Antivenom Development

Efforts are underway to develop new antivenoms that are more effective and have fewer side effects than traditional horse-derived antivenoms. Some researchers are exploring the use of recombinant DNA technology to create synthetic antibodies that can neutralize coral snake venom.

Alternative Treatment Approaches

Scientists are investigating alternative treatment approaches that could complement or potentially replace antivenom therapy. These include:

• Small molecule inhibitors that can block the action of venom components
• Nanoparticle-based therapies that can sequester venom toxins
• Improved supportive care techniques to manage symptoms more effectively

Venom Research

Ongoing research into the composition and mechanisms of coral snake venom could lead to new treatment strategies. Understanding how different venom components affect the human body may allow for more targeted and effective treatments in the future.

International Collaboration

Given the global distribution of coral snake species, international collaboration in research and treatment development is crucial. Sharing knowledge and resources across borders can accelerate progress in improving coral snake bite management worldwide.

As research continues, it’s hoped that new developments will lead to more widely available, effective, and safer treatments for coral snake bites, ultimately improving outcomes for bite victims and reducing the challenges currently faced in managing these potentially deadly envenomations.

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.

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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.

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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

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