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Related Experiment Videos

Shock due to protamine hypersensitivity

C A Cobb, D L Fung

    Surgical Neurology
    |April 1, 1982
    PubMed
    Summary
    This summary is machine-generated.

    Protamine sulfate reactions can occur even with low doses, especially in patients previously exposed through isophane insulin (NPH insulin). Careful heparin reversal is advised for such patients to avoid protamine-induced shock.

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    Area of Science:

    • Pharmacology
    • Immunology
    • Toxicology

    Background:

    • Protamine sulfate is used to neutralize heparin.
    • Isophane insulin (NPH insulin) contains protamine as a preservative.
    • Previous exposure to protamine can lead to sensitization.

    Observation:

    • A patient experienced shock and skin flush after receiving protamine sulfate.
    • The patient had a history of diabetes treated with isophane insulin.
    • Three other cases of protamine reaction involved prior protamine exposure.

    Findings:

    • Low-dose protamine sulfate can cause severe reactions in sensitized individuals.
    • Prior exposure to protamine, including via isophane insulin, is a risk factor.
    • Hypersensitivity reactions to protamine are linked to prior exposure.

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    Implications:

    • Patients with a history of isophane insulin use require cautious heparin management.
    • Avoid protamine sulfate if possible; allow spontaneous heparin reversal.
    • If protamine is necessary, premedication with glucocorticoids and availability of vasopressors are crucial.