ILLUSTRATIVE CASE
Coral Snake Bites and Envenomation in Children A Case Series Jun Sasaki, MD, Paul A. Khalil, MD, Madhuradhar Chegondi, MD, Andre Raszynski, MD, Keith G. Meyer, MD, and Balagangadhar R. Totapally, MD
Objective: North America is home to 2 families of venomous snakes, Crotalinae (pit viper family) and Elapidae (coral snake family). Although there are several published reports describing and reviewing the management of pit viper snakebites in children, there are no recent similar publications detailing the clinical course and management of coral snake envenomation. Methods: Our case series describes the hospital course of children with coral snake bites admitted to our regional pediatric intensive care. We also reviewed prior published case reports of coral snake bites in the United States. Results: We identified 4 patients with either confirmed or suspected coral snake envenomation from our hospital’s records. In 2 cases, the snakebite occurred after apparent provocation. Antivenom was administered to 3 patients. The regional venom response team was consulted for management advice and supplied the antivenom. One patient had a prolonged hospital course, which was complicated by respiratory failure, bulbar palsy, and ataxia. All survived to discharge. Conclusions: Admission to pediatric intensive care is warranted after all Eastern coral snake bites. A specialized regional or national venom response team can be a useful resource for management advice and as a source of antivenom. Key Words: snakebite, Florida, coral snake, envenomation (Pediatr Emer Care 2014;30: 262Y265)
I
n the United States, in the 1950s, 45,000 snakebites were reported each year, 8000 of which were poisonous.1 A recent comprehensive analysis of the American Association of Poison Control Centers (AAPCC) database showed that on average, from 2001 to 2005, there were 4700 native venomous snakebites reported each year.2 Ninety-eight percent of venomous snakebites in the AAPCC database were inflicted by Crotalinae (pit viper snakes) and 2% by Elapidae (coral snakes). Florida reported the largest number of coral snakebites (255 cases over a 5-year period), followed by Texas (89 cases).2 The state of Florida moved from 11th place for estimated incidence of snakebites in 19591 to second place during the period of 2001 through 2005.2 In the AAPCC reports of venomous snakebites in children aged 0 to 19 years, there were 327 to 775 snakebites per year from pit viper family (copperhead, cottonmouth, and rattlesnake) and 12 to 31 snakebites per year from the coral snake family.3Y18 Although there have been a few published reports of venomous snakebites of the pit viper family in children,19Y22 no exclusive case series has been published describing coral snake bites in children since 1966.23 The aim of From the Division of Critical Care Medicine, Miami Children’s Hospital, Miami, FL. Disclosure: The authors declare no conflict of interest. Reprints: Jun Sasaki, MD, Division of Critical Care Medicine, Miami Children’s Hospital, 3100 SW 62nd Ave, Miami, FL 33155 (e
Coral Snake Bites and Envenomation in Children A Case Series Jun Sasaki, MD, Paul A. Khalil, MD, Madhuradhar Chegondi, MD, Andre Raszynski, MD, Keith G. Meyer, MD, and Balagangadhar R. Totapally, MD
Objective: North America is home to 2 families of venomous snakes, Crotalinae (pit viper family) and Elapidae (coral snake family). Although there are several published reports describing and reviewing the management of pit viper snakebites in children, there are no recent similar publications detailing the clinical course and management of coral snake envenomation. Methods: Our case series describes the hospital course of children with coral snake bites admitted to our regional pediatric intensive care. We also reviewed prior published case reports of coral snake bites in the United States. Results: We identified 4 patients with either confirmed or suspected coral snake envenomation from our hospital’s records. In 2 cases, the snakebite occurred after apparent provocation. Antivenom was administered to 3 patients. The regional venom response team was consulted for management advice and supplied the antivenom. One patient had a prolonged hospital course, which was complicated by respiratory failure, bulbar palsy, and ataxia. All survived to discharge. Conclusions: Admission to pediatric intensive care is warranted after all Eastern coral snake bites. A specialized regional or national venom response team can be a useful resource for management advice and as a source of antivenom. Key Words: snakebite, Florida, coral snake, envenomation (Pediatr Emer Care 2014;30: 262Y265)
I
n the United States, in the 1950s, 45,000 snakebites were reported each year, 8000 of which were poisonous.1 A recent comprehensive analysis of the American Association of Poison Control Centers (AAPCC) database showed that on average, from 2001 to 2005, there were 4700 native venomous snakebites reported each year.2 Ninety-eight percent of venomous snakebites in the AAPCC database were inflicted by Crotalinae (pit viper snakes) and 2% by Elapidae (coral snakes). Florida reported the largest number of coral snakebites (255 cases over a 5-year period), followed by Texas (89 cases).2 The state of Florida moved from 11th place for estimated incidence of snakebites in 19591 to second place during the period of 2001 through 2005.2 In the AAPCC reports of venomous snakebites in children aged 0 to 19 years, there were 327 to 775 snakebites per year from pit viper family (copperhead, cottonmouth, and rattlesnake) and 12 to 31 snakebites per year from the coral snake family.3Y18 Although there have been a few published reports of venomous snakebites of the pit viper family in children,19Y22 no exclusive case series has been published describing coral snake bites in children since 1966.23 The aim of From the Division of Critical Care Medicine, Miami Children’s Hospital, Miami, FL. Disclosure: The authors declare no conflict of interest. Reprints: Jun Sasaki, MD, Division of Critical Care Medicine, Miami Children’s Hospital, 3100 SW 62nd Ave, Miami, FL 33155 (e
