Envenomation from the bite of the Gila monster (Heloderma suspectum) has been reported in the medical literature only nine times since 1956. We present an additional four cases to better define the signs and symptoms of envenomation. Frequent clinical manifestations are pain, hypotension, tachycardia, nausea, and vomiting. Gila monster teeth remaining in the wound are not detectable by soft tissue radiography. In our series, hypotension responded well to i.v. crystalloid fluid administration. We recommend at least 6 hours of observation after the bite to assess the potential for systemic toxicity.