What is the treatment for coral snake envenomation?

Updated: Apr 09, 2021
  • Author: Spencer Greene, MD, MS, FACEP, FACMT, FAAEM; Chief Editor: Joe Alcock, MD, MS  more...
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Coral snakes are elapids, not crotalids, and neither FabAV or F(ab)2AV is indicated for coral snake envenomations. There is only one FDA-approved antivenom for native coral snake envenomations. [62] The North American Coral Snake Antivenom (NACSAV) (Micrurus fulvius) (Equine Origin) was first developed in the 1960s. Production was halted in 2010. However, some lots of antivenom are still in circulation, and as of late 2019, production has resumed. Most hospitals will not keep NACSAV in stock, and it may be necessary to contact poison control to locate the antivenom or a suitable alternative.

There are several foreign antivenoms that have demonstrated efficacy against native coral snake venom. [63, 64, 65] Coralmyn®, manufactured by Bioclon, has proven to be effective in the treatment of Eastern coral snake (M fulvius) envenomations. Another antivenom, produced by Costa Rica’s Instituto Clodomiro Picado, has also been used successfully in the treatment of US coral snake envenomations.

Neostigmine is a peripherally acting cholinesterase inhibitor that can increase synaptic concentrations of acetylcholine, allowing the neurotransmitter to compete with the toxins, preventing paralysis. Several case reports have suggested a modest temporizing benefit in envenomations from coral snake and other elapids. [66, 67] There are few adverse effects from neostigmine at therapeutic doses, so it is reasonable to administer it following Eastern coral snake (M fulvius) envenomations in which the likelihood of objective neurotoxicity is high.

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