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Protamine-Induced Bradycardic Arrest in a Diabetic Patient
Brooke A McDonald1, Kevin G Buda1, Jeffrey R Hall1
1Internal Medicine, Hennepin County Medical Center, Minneapolis, USA.
Cureus
|November 19, 2020
Summary
Protamine sulfate can cause dangerous heart rhythm changes, even without prior allergy. Diabetic patients are at higher risk for these protamine-induced arrhythmias, necessitating careful medication review.
Area of Science:
- Cardiology
- Pharmacology
- Anesthesiology
Background:
- Protamine sulfate is a standard heparin reversal agent.
- Adverse event epidemiology is not well-established.
- Risk factors include prior protamine allergy and NPH insulin use.
Observation:
- A 68-year-old woman experienced bradycardic arrest post-protamine infusion.
- She had no prior history of protamine sulfate intolerance.
Findings:
- Protamine sulfate infusion can precipitate life-threatening tachyarrhythmias and bradyarrhythmias.
- Diabetic patients may be at increased risk due to potential autonomic dysfunction.
Implications:
- Healthcare providers must be vigilant for protamine-induced cardiac arrhythmias.
- Thorough medication and allergy reviews are crucial before heparin reversal, particularly in diabetic patients.
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