malaise, lymphadenopathy, fever, and/or GI symptoms that evolve over several days Prednisone (2 mg/kg/day, maximum 80 mg) until symptoms abate (and then a tapering schedule) has been used with success in most cases Diphenhydramine (5 mg/kg/day in four divided doses, max 50 mg/dose) is often given as an adjunct Coral snake When coral snake wounds are present or the history or specimen is consistent with an Eastern or Texas coral snakebite, antivenin for M fulvius (Wyeth) if available should be administered before development of further symptoms As Wyeth no longer manufactures the coral snake antivenin and there are currently no other FDA-approved alternatives in the United States, there have been multiple extensions of the original expiration date on vials Hence, in the United States, antivenin should be restricted to patients with systemic symptoms This antivenin is also an equine serum and requires preliminary skin testing (see package insert), although 10% of patients can have a false-negative test Pediatric patients should be closely monitored for signs of anaphylaxis The use of antivenin in pregnancy should be considered on a case-by-case basis The initial recommended dosage is three to five vials by IV; an additional three to five vials may be given as needed for signs of venom toxicity There is no antivenin available for the Arizona coral snake (M euryxanthus ) Supportive care should provide a satisfactory outcome in these cases Constriction bands, suction and drainage, and other local measures not retard coral snake venom absorption, and hence are not indicated All patients that present to the ED with a coral snakebite should be observed for at least 24 hours Exotic snakes The clinician confronted with an exotic snakebite or a clinician inexperienced in snakebites should consult a local medical herpetologist or the American Association of Zoologic Parks and Aquariums and the American Association of Poison Control Centers These centers keep an up-to-date database of exotic antivenoms Access to this information is available at 800-222-1222 Report all illegally possessed reptiles to the police or to the appropriate fish and game agency Venomous lizards The two lizards that are potentially dangerous for humans that the emergency provider needs to be aware of are the Gila monster (Heloderma suspectum ) of the southwestern United States and adjacent areas of Mexico and the Mexican beaded lizard (Heloderma horridum ) of western Mexico south to Guatemala Their venom from submandibular glands contains peptides, such as exendins-3 and -4, which are glucagon-like peptide-1 analogs Bites are typically provoked and can cause severe local pain, swelling, and regional lymphadenopathy along with systemic symptoms, such as dizziness, hypotension, angioedema, sweating, rigors, tinnitus, nausea, and vomiting