Bitten by a copperhead snake? How to know if you need antivenom or an ER visit.

Many people who get bitten by copperhead snakes assume they need antivenom to treat the bite, but that’s not always the case, doctors say.

In fact, Dr. Michael Beuhler, NC Poison Control’s medical director, says antivenom is only sometimes necessary.

The high cost of antivenom and risk of allergic reaction are two deciding factors against administering the drug, he said.

“You’re doing a risk to benefit ratio. Is the cost of antivenom worth it?” Beuhler said.

“Most of the time, antivenom just gets you on your feet a few days quicker — is it necessary to spend this much money administering antivenom when you’ll be fine by the next month anyway?”

The N&O spoke with three doctors — and with three North Carolina residents recently bitten by copperheads — to get a better understanding of when emergency room visits and antivenom treatments are necessary.

Snake antivenom pros and cons, including costs

Dr. Ben German, an emergency department physician at WakeMed who specializes in snake bites, said WakeMed tries to offer antivenom to anyone they think will benefit.

While it’s extremely rare to die from a copperhead bite, the bites can cause significant morbidity, including pain, swelling, disfigurement and sometimes the loss of a finger or toe. It can sometimes take months to return to full function, he said.

WakeMed talks to patients about benefits and risks associated with antivenom, German said.

▪ Benefits can include reduced tissue damage, decreased need for opioids or other pain medications and earlier return to function.

▪ Risks can include allergic reactions, failure for the antivenom to resolve all symptoms and cost.

“When we’re treating them, we mention that if you don’t have insurance, you might be looking at a really high bill, which is a factor for some people not to get antivenom,” German said. “Not to dissuade anyone from receiving antivenom, but to make sure they have the information to make an informed decision based on their unique circumstances.”

Antivenom at WakeMed costs between $11,000 and $14,000 per vial, spokesperson Kristin Kelly said. For the typical initial dose of four to six vials, this costs at least $44,000.

UNC Health charges between $76,000 and $115,000 for the typical initial dose, The N&O previously reported. Duke Health declined to share current figures, but The N&O reported in 2020 that 12 vials cost $200,000.

Insurance and other negotiated discounts significantly lower the amount the patient is responsible for paying.

WakeMed consults NC Poison Control for every single snake bite case they encounter, Kelly said. Many other hospitals in the area do the same.

If symptoms are mild, call NC Poison Control first

If you get a copperhead bite and don’t have concerning symptoms (difficulty breathing or chest pain, for example), call NC Poison Control first, Beuhler said.

Chatting with a medical expert at NC Poison Control — a free, 24/7 service for people in North and South Carolina— costs you nothing besides the time you spend on the phone. If you end up going to the hospital, Poison Control will assist caregivers and check in with you after discharge, he said.

You can contact NC Poison Control at their 24/7 hotline (1-800-222-1222) or by chatting on their website: ncpoisoncontrol.org.

This year, Poison Control is relying on the use of photos to help them make more care decisions, as more people calling the hotline have cameraphones.

“A lot of the people who contact us are developing symptoms beyond something minor, we recommend to them that they need to be seen. If they’re experiencing dizziness, difficulty breathing, significant swelling… those are concerning symptoms that need to be evaluated at a hospital.”

Half of copperhead bites are dry or really mild. About 46% of the bites Poison Control was involved in treating received antivenom, Beuhler said, though the absolute treatment rate is unknown.

“You can get a tetanus shot from your pharmacy and clean the wound yourself — why take a trip to the ER and pay ER bills if you don’t have to? Let us help you make that decision and save you a potentially really expensive few hours,” he said.

How do doctors decide when to administer antivenom?

There’s a well-established grading scale that doctors follow, said Dr. Jason Hack, chief of the Division of Medical Toxicology at East Carolina University.

Doctors look at swelling, vital sign abnormalities and lab data to determine whether they should administer antivenom for a copperhead bite. Envenomations can be minimum, moderate or severe.

“If it’s copperhead bite, we’ll draw a line at the part of your body where the swelling is,” Hack said. “Every 30 minutes, we’ll draw another line to see how the swelling has moved, and we’ll check vitals again.”

If the swelling moves around the body quickly, that’s a sign to administer antivenom. If the swelling stays in the same spot after a few checks, and vitals are looking good, the patient might not need it, he said.

The N&O spoke with three people who were all bitten by copperheads this summer (and have since fully recovered) to get an idea of what their treatment looked like.

Case 1: Young boy’s copperhead bite didn’t need antivenom

When 11-year-old Tobin Kivett was bitten by a copperhead on his leg last month after helping to trim some bushes around his home in Raleigh, his mother took him to UNC Rex Hospital.

“They didn’t have to give him any antivenom, which they said they don’t give unless they have to,” his mother, Kelly Kivett, told The N&O. “Some people respond really negatively or have an allergic reaction to antivenom, and they monitored my son’s bite for a while, eventually concluding he didn’t need it.”

Doctors drew lines on Tobin’s leg and came in every hour to monitor swelling. Since the swelling didn’t move up his leg toward his groin, they determined antivenom wasn’t necessary, she said.

Tobin only needed to keep pressure off his leg for a couple days, and it took a little over a week for the swelling and bruising to totally go away, she said.

Rex doctors told her their snake bite protocol comes from NC Poison Control, she said.

“With it being my first experience with a snake bite, I’m glad I went. But we didn’t know to call Poison Control,” Kivett said. “In the future, I’ll probably call them first.”

She was told to expect to pay about $500, though she hasn’t received the bill yet, she said.

Case 2: No antivenom for copperhead bite on adult’s foot

Lauren Stroud, who lives in Statesville, was bit by a copperhead on the arch of her left foot in June. She went to Iredell Memorial Hospital that evening and was monitored overnight, she said.

She didn’t receive antivenom. “According to the doctors there, you only receive antivenom if they feel you are in dire need. Typically, copperheads don’t warrant it,” Stroud told The N&O.

The hospital called NC Poison Control while she was there, she said. Stroud said she would have called herself before heading to the hospital if she had known Iredell consults the group for snake bites.

Poison Control followed up with her a couple times over the next two weeks to monitor her safety, she said. They asked her to rate her pain on a one to 10 scale, instructing her to call them back if anything felt strange.

Because Stroud has Medicaid, the visit was at no cost to her, she said.

Case 3: Antivenom administered for finger bite in Raleigh

Eva Lee, a political activist who lives in Raleigh, got bitten by a copperhead on her finger on Saturday. She immediately went to UNC Rex Hospital, where she was given antivenom. She doesn’t know how many vials she received, she said.

Lee’s hand swelled quickly, and she was adamant about receiving antivenom.

“The doctor asked me a few times, ‘Do you have insurance?’ when I knew they had my insurance on file,” Lee said. “I finally said ‘I’m not afraid of the medical bill, just give me the antivenom.’”

Her copay for the Emergency Room visit came out to $1,250 with her insurance, she said. She’s not sure if the cost of labs will be added to her bill later.

What to do if you’re bitten by a copperhead (or other snake)

IF YOU HAVE BEEN BITTEN BY A SNAKE, YOU SHOULD:

• Sit down and stay calm.

• Gently wash the bite area with warm, soapy water.

• Remove any jewelry or tight clothing near the bite site.

• Keep the bitten area still, if possible, and raise it to heart level.

• Call the NC Poison Control: 1-800-222-1222.

Note: If a snakebite victim is having chest pain, difficulty breathing, face swelling or has lost consciousness, call 911 immediately.

IF BITTEN BY A SNAKE, YOU SHOULD NOT:

• Cut the bitten area to try to drain the venom. This can worsen the injury.

• Ice the area. Icing causes additional tissue damage.

• Apply a tourniquet or any tight bandage. It’s actually better for the venom to flow through the body than for it to stay in one area.

• Suck on the bite or use a suction device to try to remove the venom.

• Attempt to catch or kill the snake.

(Source: NC Poison Control)

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