Epidemiology, Clinical Features, and Management of Texas Coral Snake (Micrurus tener) Envenomations Reported to the North American Snakebite Registry

• DOI: 10.1007/s13181-020-00806-3
• Publication Date: 2020-08-14T17:03:10Z
• Authors: Spencer Greene; Anne-Michelle Ruha; Sharan Campleman; Jeffrey Brent; Paul Wax; ; Kim Aldy; Peter Akpunonu; Vikhyat S. Bebarta; Gillian A. Beauchamp; Michael C. Beuhler; Mary Billington; William Boroughf; Robert D. Cannon; E. Martin Caravati; Edward Cetaruk; Alex Chen; James Chenoweth; Matthew D. Cook; Lynn Farrugia; Steven Fishburn; Erik Fisher; Jonathan B. Ford; Jakub Furmaga; Stephen Alex Harding; Benjamin Hatten; Bryan Judge; Kenneth D. Katz; William P Kerns; Kurt Kleinschmidt; Andrew L. Koons; David B. Liss; Jennifer Lowry; Kevan Meadows; Alicia Minns; Michael Mullins; Angela PadillaJones; Tammy Phan; Lauren Porter; Ashley Carter-Powell; Sarah Shafer; Evan S. Schwarz; Meghan Spyres; Ryan M. Surmaitis; Laura Tortora; Stephanie Weiss
• Keywords: Adult; Male; Adolescent; Micrurus tener; Clinical Sciences; Pain; Snake Bites; Opioid; Coral Snakes; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Clinical Research; Animals; Edema; Humans; Snakebite; Paresthesia; Registries; Preschool; Child; Envenomation; Aged; Elapid Venoms; Analgesics; Pain Research; Neurosciences; Pharmacology and Pharmaceutical Sciences; Venom; Texas; 3. Good health; Coral snake; Analgesics, Opioid; Treatment Outcome; Erythema; ToxIC Snakebite Study Group; Child, Preschool; Antiemetics; Female

Few of the 5000-8000 snakebites reported to poison control centers annually in the USA are attributed to coral snakes. This study describes Texas coral snake envenomations reported to the North American Snakebite Registry.All Texas coral snake envenomation cases reported to the registry were identified for the period from January 1, 2015, through December 31, 2019. Data reviewed for this study included details regarding the snake encounter, patient demographics, signs and symptoms, treatment, and outcomes. Descriptive statistics were used to report results.Ten men and four nonpregnant women reported coral snake bites. The median patient age was 15.5 (range 5-72 years). There were 12 upper extremity bites and two bites to the lower extremity. The most common symptoms reported were paresthesias and pain. All subjects had paresthesias, often described as an "electric" sensation. Seven patients described them as painful. The most common clinical findings were erythema and swelling. No patient developed tissue damage, hematotoxicity, rhabdomyolysis, hypotension, weakness, or respiratory symptoms. Thirteen subjects were treated with opioids. Six patients were treated with antiemetics: three prophylactically and two for opioid-induced nausea. One patient developed nausea and non-bloody, nonbilious emesis within 1 hour of the bite, prior to receiving opioids. No patients were treated with antivenom. Antibiotics were not administered to any patient, and no infections were reported.Envenomations from M. tener in Southeast Texas are characterized by painful paresthesias. Mild swelling and erythema are common. Neurotoxicity necessitating antivenom or mechanical ventilation did not occur.