Eastern Coral Snake Envenomation Research Articles

A retrospective evaluation of eastern coral snake envenomation and antivenom administration in cats: 30 cases (2012–2019)

Thirty cats were identified to be have been suspected to have a potential coral snake envenomation after searching medical records from 2012 to 2019 at a university teaching hospital. The records were reviewed and evaluated for signalment, date and time of the snake encounter, elapsed time between encounter and hospital examination, presenting complaint, initial physical examination findings, initial laboratory findings, antivenom dose and duration of administration, adverse reactions to antivenom, additional treatments administered, progression of clinical signs, length of hospitalization, and outcome. Thirteen cats presented with clinical signs consistent with envenomation while 17 cats were treated for possible asymptomatic envenomation, as defined by the owner discovering a live or dead coral snake in their home or on their property. Initial physical examination findings included tachypnea with short shallow breaths and use of accessory muscles; tetraparesis with normal or decreased to absent spinal reflexes; cranial nerve deficits including decreased to absent gag, slow pupillary light reflexes, and absent physiologic nystagmus; and normal or altered mentation. Laboratory findings included hypercapnia, hyperglycemia, hypokalemia, increased aspartate aminotransferase activity, increased alanine aminotransferase activity, echinocytosis, leukocytosis, azotemia, and hyperlactatemia. Twenty-eight cats received antivenom; two cats received two vials while twenty-six cats received one vial. Antivenom reaction was suspected in one cat that developed facial swelling during administration of the drug. Average length of hospitalization was 1 day for cats without clinical signs and 3 days for cats with clinical signs. Twenty-nine cats survived to discharge. Due to the inclusion criteria of the study, cats euthanized on presentation or discharged without receiving antivenom may have been unintentionally excluded from the study.Diagnosis of eastern coral snake envenomation should be suspected in the cat that has acute onset of lower motor neuron neuropathy. Prognosis with treatment is considered good with 97% of cats surviving to discharge. Antivenom reaction occurred in 3.5% of administrations with none being fatal. Monitoring of hypercapnia was critical in making the decision to mechanically ventilate patients. Supportive care that includes antivenom administration, recumbency care, and mechanical ventilation if needed are the mainstays of therapy.

Retrospective evaluation of Micrurus fulvius (Eastern coral snake) envenomation and the use of mechanical ventilation in dogs and a cat (2011-2016): 8 cases.

To describe the use of mechanical ventilation (MV) in the management of Eastern coral snake envenomation in 7 dogs and a cat. Retrospective study (2011-2016). University teaching hospital. Seven dogs and 1 cat receiving MV for ventilatory failure secondary to Eastern coral snake envenomation. None. The medical records of 8 animals that received MV following Eastern coral snake envenomation were reviewed. Data collected included signalment, time to veterinary assessment, physical and laboratory characteristics at arrival, clinical course during hospitalization, management including antivenom administration, MV settings, duration of ventilation, length of hospitalization, cost of care, and survival to discharge. The mean ± SD age was 4 ± 3.2 years. Median (range) time to onset of clinical signs was 30 (5-240) minutes. Coral snake antivenom was administered to 7 of the 8 animals following arrival at a median (range) of 30 (5-90) minutes. All animals had progressive hypoventilation and received MV, specifically volume controlled, synchronized intermittent mandatory ventilation with pressure support. The median (range) duration of MV was 58 (25-84) hours and the median (range) duration of hospitalization was 8.2 (6-11) days. Ventilator associated complications occurred in all animals, but overall outcome was excellent with 7 of 8 surviving to discharge. No dog, but the 1 cat, had an adverse reaction to antivenom. Ventilatory failure secondary to Eastern coral snake envenomation necessitating MV carries an excellent prognosis and is better than reported for other causes of lower motor neuron disease. Successful response to ventilation was achieved even with associated complications being common in this cohort of animals.

A retrospective evaluation of coral snake envenomation in dogs and cats: 20 cases (1996–2011)

To describe the clinical signs, treatment, and outcomes of dogs and cats following envenomation by the eastern coral snake and to report our clinical experience with the use of Coralmyn. Retrospective study (1996-2011). University teaching hospital. Sixteen dogs and 4 cats with eastern coral snake envenomation. Medical records meeting the study inclusion criteria were reviewed and evaluated for signalment, date and time of the snake encounter, elapsed time between encounter and hospital examination, initial physical examination findings, antivenom type, length of hospitalization, and outcome. Initial physical examination findings included: quiet mentation, tetraparesis, ptyalism, tachypnea, abdominal breathing, shallow breathing, decreased to absent gag reflex, ataxia, muscle fasciculations, and decreased spinal reflexes. Laboratory findings in dogs included proteinuria, bilirubinuria, hemeproteinuria, increased aspartate aminotransferase activity, increased alanine aminotransferase activity, and hemolysis. Four dogs and 2 cats received Coralmyn and 4 dogs received North American Coral Snake Antivenom. Adverse reaction to antivenom was suspected in 1 dog that received North American Coral Snake Antivenom. Eight of 11 envenomated dogs survived with a median length of hospitalization of 4.5 days. Two of 3 envenomated cats survived with a median length of hospitalization of 4 days. Two dogs were euthanized, 1 dog suffered acute respiratory arrest, and 1 cat developed tachycardia that progressed to pulseless electrical activity. Five dogs and 1 cat in the encounter group survived to discharge. Diagnosis of eastern coral snake envenomation is likely in the dog that has concomitant lower motor neuron neuropathy, bulbar palsy, and hemolysis. Early diagnosis is crucial as antivenom administration can reduce morbidity. Prognosis is considered good with 71% of the envenomated patients in this study surviving to discharge. Supportive care that may include ventilator assistance and antivenom administration are the mainstays of therapy.