Horse serum is used to create coral snake antivenom, or more specifically, North American coral snake antivenom, which binds to snake venom and renders it harmless.

North American coral snake Antivenom (Micrurus fulvius) Uses:

• Micrurus fulvius fulvius (Eastern coral snake) or M. f. tener (Texas coral snake) envenomation:

  • used to treat envenomation caused by a Texas coral snake or an Eastern coral snake (M. f. fulvius) (M. f. tener). The management of other Micrurus species might not be successful with the antivenin.

Coral snake antivenom Dose in Adults

Coral snake antivenom Sensitivity testing:

• A skin test that is administered intradermally should be done before antivenin is given.

Coral snake antivenom Dose in the Skin test:

Intradermal:

• 0.02 to 0.03 mL of normal horse serum or antivenin diluted 1:10;
• Comparing results to a control test (intradermal injection of NS on the opposite extremity).
• If the patient's medical history points to hypersensitivity, a dilution of 1:100 or higher should be utilised.

Note: An urticarial wheal with or without pseudopodia that appears within 5 to 30 minutes and is encircled by a zone of erythema is a sign of a good reaction.

Coral snake antivenom Dose in the Desensitization:

Note: Prepare antivenin dilutions in NS of 1:10 and 1:100 in separate vials or syringes.

SubQ:

• At intervals of 15 minutes, inject 0.1, 0.2, and 0.5 millilitres of the 1:100 dilution.
• During this process, only administer the subsequent dose if there was no reaction to the preceding dose.
• Use the 1:10 dilution first, then the undiluted antivenin, then repeat the procedure.
• After administering 0.5 mL of undiluted antivenin, if no reaction has occurred, switch to intramuscular administration and double the dose every
• 15 minutes until the entire dose has been given, or provide the standard intravenous dose.
• Apply a tourniquet close to the injection site and give epinephrine (1 mg/mL) there or into another extremity if a reaction develops. Give another antivenin injection at the same dilution as the last one that didn't work after waiting for at least 30 minutes.

Micrurus fulvius (Eastern coral snake) or M. tener (Texas coral snake) envenomation:

• IV: Depending on the severity of the indications and symptoms, 30 to 50 mL (3 to 5 vials) via gradual injection
• More than 10 vials may be required for some patients.

Note:

• Antivenom neutralises about 2 mg of venom every vial.
   

Coral snake antivenom Dose in Childrens

Refer to adult dosing. 

Pregnancy Risk Category: Not assigned

• In general, the mother's health and prognosis should be taken into account when choosing pharmaceuticals to be used as antidotes.

Coral snake antivenom Dose in Kidney Disease:

• No dosage adjustments provided in the manufacturer’s labeling.

Coral snake antivenom Dose in Liver Disease:

• No dosage adjustments provided in the manufacturer’s labeling.

Side effects of Coral snake antivenom:

• Immediate reactions:

  • Immediate effects might start before the needle is removed and can happen within 30 minutes.
  • Symptoms include:
    • laryngeal edema
    • collapse
    • urticaria
    • cough
    • dyspnea
    • flushing
    • pruritus
    • cyanosis
    • tongue edema
    • facial edema
    • vomiting
    • apprehension

• Cardiovascular:

  • Shock

• Hypersensitivity:

  • Hypersensitivity reaction
  • Anaphylaxis

• Delayed reactions:

  • Reactions that are delayed happen 5 to 24 days after administration.
  • Symptoms include:
    • vomiting
    • malaise
    • fever
    • nausea
    • edema
    • urticaria
    • lymphadenopathy
    • Neurological symptoms 
    • arthralgia

• Hypersensitivity:

  • Serum sickness

Contraindications to Coral snake antivenom (Micrurus fulvius):

• Patients with life-threatening or life-threatening envenomation are not subject to any contraindications
• The concurrent use of opioid analgesics and other analgesics that slow breathing is contraindicated.

Notice:

• Patients who have severe, immediate hypersensitivity reactions to antivenin (Micrurus Fulvius) and horse serum must be managed by clinicians in advance.
• This is based on either the history or the results of sensitivity tests.

Warnings and precautions

• Delayed serum sickness:

  • Even if there is no reaction to the skin test or negative allergy history, delayed serum sickness can occur within a few weeks.

• Hypersensitivity to horse serum

  • Take the time to review your allergies and past exposure to horse serum products.
  • A history of horse atopic sensitivity may increase the likelihood of experiencing a heightened sensitivity reaction.
  • Patients with asthma, hay fever, and urticaria should be cautious.

Monitoring Parameters:

• oxygenation
• urine for hemoglobinuria
• respiratory function
• Symptoms of envenomation disappearing or signs of antivenin hypersensitivity developing

How to administer Coral snake antivenom (Micrurus fulvius)?

IV:

• Have quick access to resuscitation tools and drugs.
• Start an intravenous infusion of 250 to 500 mL of NS, and administer gradual injections of antivenin or doses using a reservoir bottle.
• Inject the initial 1 to 2 mL of antivenin over the course of 3 to 5 minutes, carefully monitoring the onset of an allergic reaction.
• Tolerance to the remaining antivenin will control the rate of infusion.

Mechanism of action of Coral snake antivenom (Micrurus fulvius):

• The effects of the venom from the Eastern coral snake (Micrurus fulvius) and Texas coral snake (Micrurus tener) are blocked by antibodies because they neutralise the venom components.

International Brands of North American coral snake (Micrurus fulvius) antivenom:

• Coral snake antivenom brands not mentioned.

North American coral snake (Micrurus fulvius) antivenom Brand Names in Pakistan:

No Brands Available in Pakistan.