Q: When was the last documented death from a coral snake (Micrurus fulvius) envenomation?

This question came up during our Montana WALS course last week in Red Lodge.  Richard Gates from WMI reminded the lead instructor Dr. Will Smith (and us) of a report from 2006 of an unconfirmed case.  When I googled this last evening I found out that it has in fact been confirmed.  There is an article about the case appearing this month in Toxicon. 

Why is this important?  It is a reminder that despite the rarity, these bites can be lethal (only the second in 40+ years).  Antivenin has been the treatment of choice.  The problem of course is that Wyeth has not produced that antivenin for several years.  It was scheduled for expiration in October 2008 but was extended through Oct of 2009.  Do you know what to do?  Will there be anything available other than supportive care?  Would a pressure bandage like those used in other countries on more potent neurotoxins make a difference?  Dr Norris of Stanford, the lead author, has written and lectured on snake envenomations and updated the WMS lecture series () on envenomations for 2009.  He had an article published in 2005 commenting on pressure immobilization techniques and how effective lay providers are in applying one.  I look forward to reviewing the article when it arrives.  By the way, the equine Crotalidae (pt vipers) antivenin has also expired and was not extended.  Fortunately we have CroFab antivenom. 

 

If you are really interested in this stuff, I would suggest you try and attend Venom Week 2009 in NM starting 1 June ().  It sounds like quite a line-up.  It includes one of my favourites, Rick Vetter, an entomologist who has written about spider bite misdiagnosis and arachnophobia.  I wish I could go.  If anyone reading this does attend please send us some pearls of wisdom. 

Also, check out the Miami-Dade Fire Rescue Venom Response Program().  According to their web page they “…maintain the largest and only antivenom bank for public use in the United States.”  They have have antivenoms for a all domestic and many international species that may have been imported into the US. 




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