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

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Abstract

Introduction

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.

Methods

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.

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.

Conclusions

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.

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Acknowledgments

The ToxIC North American Snakebite Study Group: 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, Spencer Greene, Stephen Alex Harding, Benjamin Hatten, Bryan Judge, Kenneth D. Katz, William P Kerns II, 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.

The authors would like to thank Brittany Kinsey for her photograph of a Texas coral snake, Micrurus tener.

Funding

ACMT receives grant support from BTG International to support the North American Snakebite Registry. None of the authors received financial compensation for their participation in this work.

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA

    Spencer Greene

  2. Unviersity of Texas Health Science Center Cizik School of Nursing, 6711 Stella Link Rd, Houston, TX, 77005, USA

    Spencer Greene

  3. Department of Medical Toxicology, Banner, University Medical Center Phoenix, Phoenix, AZ, USA

    Anne-Michelle Ruha

  4. American College of Medical Toxicology, Phoenix, AZ, USA

    Sharan Campleman & Paul Wax

  5. University of Colorado School of Medicine, Denver, CO, USA

    Jeffrey Brent

  6. Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Paul Wax

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  1. Spencer Greene
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Consortia

on behalf of the ToxIC Snakebite Study Group

  • 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 II
  • , 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

Corresponding author

Correspondence to Spencer Greene.

Ethics declarations

The ToxIC Registry has approval from the Western Institutional Review Board.

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Supervising Editor: Eric J. Lavonas, MD, MS

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Greene, S., Ruha, AM., Campleman, S. et al. Epidemiology, Clinical Features, and Management of Texas Coral Snake (Micrurus tener) Envenomations Reported to the North American Snakebite Registry. J. Med. Toxicol. 17, 51–56 (2021). https://doi.org/10.1007/s13181-020-00806-3

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  • DOI: https://doi.org/10.1007/s13181-020-00806-3

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