Reptile & Amphibian Forums

PALM BEACH POST (Florida) 12 April 08 Dwindling snake-venom antidote worries experts (Stacey Singer)
They're undeniably pretty, and so timid you could pick one up, if you dared.
Curious boys and small dogs often do. But once disturbed, the venomous coral snake snaps.
On Tuesday, a 15-year-old Vero Beach teen took a bite to the hand, and had to be hospitalized and pumped with seven vials of coral snake antivenin. He survived.
A Delray Beach dachshund succumbed to a bite in March. In April, a Jensen Beach Jack Russell died.
The spate of recent coral snake bites has emergency doctors sounding an alarm — not about the abundance of the colorful snakes, but about the dearth of antidote.
Florida's the coral-snake-bite capital of the United States, with about 45 of the nation's annual 60 bites. The bite of a coral snake packs a venom so toxic it's akin to a cobra's, but with treatment, it's survivable.
While there was a time when most every emergency room in South Florida kept the antidote on hand, those days have passed.
Drugmaker Wyeth quietly stopped making it three years ago, leaving the state's poison control system to parse out dwindling supplies.
It's not an ideal situation, said Dr. Jeffrey Bernstein, medical director for the Florida Poison Information Center in Miami. Coral snake bites are best treated before the onset of symptoms.
Bernstein keeps a spreadsheet with the location of every vial of antivenin in the region, and when a call comes in, he routes it by ambulance or air.
In the case of the Vero Beach teen, the nearest vials were in Melbourne, at Holmes Regional Medical Center. It took two hours and 15 minutes for their two vials to arrive at the boy's hospital, Indian River Medical Center.
But he needed more than two vials, said Glenn Tremml, medical director of emergency services at Indian River.
Miami-Dade Fire Rescue's Venom Response unit marshaled 10 more and airlifted them to the boy, an operation that took two and a half hours.
Fortunately, the antidote arrived in time, and by Wednesday night, the teen had recovered enough to return home.
But Tremml worries about the future.
"What antivenin we have left on the shelf will expire in October of 2008," he said.
Coral snake venom is different than that of other poisonous snakes.
Rattlesnakes pre-digest their food, using their copious venom to disintegrate tissue around the bite. The same is true of cottonmouths. A commercially available drug blocks the tissue damage of both.
But coral snakes paralyze their prey, then digest them, said Alan Tennant, author of A Field Guide to Snakes of Florida.
"The reason it's so crucial to get antivenin for a coral snake bite is it's a neurotoxin," Tennant said. "You get eyelid drop, your head flops over and, the danger is, the diaphragm will stop breathing and you'll suffocate."
The antivenin is made by injecting horses with the venom, then harvesting their serum antibodies — a costly process, and one fraught with liability risks, because severe allergic reactions to the horse-based products are common. Still, the medicine's very effective, said Bernstein, who is also a University of Miami toxicologist.
So what happens when Florida's last vial of coral snake antivenin expires or runs out?
"Whatever is on the shelf is what there is," he said.
After that, Mexican and Costa Rican antivenin will be used, imported by a team of poison control specialists in Miami with special emergency approval from the U.S. Food and Drug Administration, he said.
"It works. We've used it," Bernstein said. "But no, I can't tell you it's well studied in humans. It's not an FDA approved drug."
Mary Long, a spokeswoman for the FDA, said the agency cannot force a company to make a product, nor can she comment on foreign-made drugs.
"What I can say is that product shortages are of great concern to the agency, as they can post public health risks," Long added.
Worst-case, if there is no antivenin available, a bite victim can be kept alive on a respirator until the crisis passes.
As long as there are coral snakes around, people are going to suffer bites, Tennant predicted. They're one of the most beautiful snakes a person can see, with glossy scales that gleam red, yellow and black. Usually, they stay hidden in leaf litter and mulch. But spring brings them out of their winter doldrums to find mates and lay eggs. Similarly colored king snakes are harmless, but they're nocturnal. A red, yellow and black snake seen during the day is most likely a coral snake.
"There's one main reason people get bit. They say, 'Look at this little snake he's real docile.' Then they pick it up and he's a snapping fool," Tennant said. "One quick bite is all it takes."
Bernstein said people should treat snake bites like a medical emergency. Call 911, and call the Florida Poison Information Center at (800) 222-1222.
"You want to get to the hospital as quickly as you can," he said.
Dwindling snake-venom antidote worries experts

PALM BEACH POST (Florida) 15 April 08 Find snake bite antidote
Bad enough that the supply of coral snake antivenin will be depleted by October. Worse, as The Post reported Sunday, the Food and Drug Administration takes the airy attitude that the agency can't force a company to make the product.
Drug-maker Wyeth stopped making the antidote three years ago. Florida's poison control system distributes the dwindling supply. Certainly the federal government has options. It could assign a government lab to make the antivenin. It could provide grants or other incentives to entice a private company to resume producing the antivenin. Until this crisis passes, the government may need to do both.
Having an adequate supply of antivenin is particularly important in Florida, where three-fourths of the annual 60 coral snake bites reported nationwide take place. A 15-year-old Vero Beach boy, the latest to need the antivenin, survived last week after receiving seven vials of the now-precious antidote. Two small dogs, in Delray Beach and Jensen Beach, recently died from coral snake bites. Coral snakes are more docile than rattlesnakes, but their venom is much more powerful.
With the supply so near depletion, the FDA has granted emergency approval for the importation of antivenin from Mexico and Costa Rica that appears to be effective. But a University of Miami toxicologist points out, correctly, that the foreign antivenin is "not an FDA-approved drug."
Given all the coastal development in South Florida, snake bites might seem far less of a threat than they were decades ago. But snakes remain a part of the landscape, and public awareness of the difference between the poisonous coral snake and the harmless king snake may be low. If a drug company in the United States can't find a reason to make the antidote, the government should offer one, or produce the antidote as a public service.
Find snake bite antidote