title: Review of Eastern coral snake (Micrurus fulvius fulvius) exposures managed by the Florida Poison Information Center Network: 1998-2010.
abstract: BACKGROUND
  Envenomation by the Eastern coral snake is rare but may be associated with significant morbidity. While effective, acquisition of North American Coral Snake Antivenin (NACSAV) is difficult because production was discontinued for many years.
  
  
  OBJECTIVE
  The purpose of this study is to characterize coral snake exposures in Florida and determine the effects of varying treatment paradigms on patient outcomes.
  
  
  METHODS
  This study is an observational case series of cases received at Florida poison centers. Included cases were Eastern coral snake exposures occurring between January 1, 1998 and October 31, 2010. Excluded cases included those found to be unrelated or those not followed for at least 24 h post envenomation. Case comments were reviewed to obtain data. Comparisons were made between asymptomatic patients receiving empiric antivenom therapy (empiric group) and those asymptomatic patients who received antivenom upon developing signs of systemic envenomation (withhold group).
  
  
  RESULTS
  Of the 553 cases identified, 387 were included in the final analysis. According to case comments, 56.3% of patients had no reported systemic symptoms. Most commonly, patients were reported to have pain (40.6%), paresthesias (28.4%), nausea (12.7%), and emesis (11.4%). NACSAV was administered to 252 patients (65%). Of those patients receiving NACSAV, 18.25% were reported to have had an adverse reaction. Patients in the withhold group (n = 106) had significantly fewer minor, moderate, and major outcomes than patients in the empiric group (n = 134, p < 0.01).
  
  
  CONCLUSIONS
  While patients in the withhold group had favorable outcomes compared with those in the empiric group, this strategy cannot be applied to all patients presenting asymptomatic to healthcare facilities due to study limitations.
  
  
  CONCLUSIONS
  Further studies are needed to determine what treatment strategy is most appropriate for asymptomatic patients presenting to healthcare facilities.
authors: Department of Pharmacy, Nemours Children's Hospital , Orlando, FL , USA.
authors: A
authors: A
authors: Wood
authors: J
authors: J
authors: Schauben
authors: J
authors: J
authors: Thundiyil
authors: T
authors: T
authors: Kunisaki
authors: D
authors: D
authors: Sollee
authors: C
authors: C
authors: Lewis-Younger
authors: J
authors: J
authors: Bernstein
authors: R
authors: R
authors: Weisman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000997:Antivenins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004546:Elapid Venoms / Q000506:poisoning*; D017815:Elapidae; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011039:Poison Control Centers / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012909:Snake Bites / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000997:Antivenins; D004546:Elapid Venoms