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Hypertension associated with protamine sulfate administration

J M Andersen, T A Johnson

American Journal of Hospital Pharmacy

|May 1, 1981

Summary

Excess protamine sulfate administration during hemodialysis can cause adverse reactions. This case report suggests protamine sulfate

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Area of Science:

Nephrology
Pharmacology
Critical Care Medicine

Background:

Protamine sulfate is used to neutralize heparin during hemodialysis.
Patients with chronic renal failure (CRF) undergoing hemodialysis are at risk for complications.
Adverse reactions to protamine sulfate can occur, necessitating careful monitoring.

Observation:

A 76-year-old woman with CRF experienced symptoms including shortness of breath, hypertension, and tachycardia during hemodialysis.
These reactions occurred after intravenous administration of protamine sulfate to neutralize heparin.
In one instance, the patient experienced hypotension followed by hypertension and incontinence.

Findings:

The patient's adverse reactions correlated with the administration of excess protamine sulfate, exceeding the amount needed to neutralize heparin.
It is hypothesized that excess protamine sulfate acted on platelets, leading to the release of histamine or serotonin.
These released substances are believed to mediate the rapid cardiovascular and respiratory changes observed.

Implications:

This case highlights the critical importance of precise dosing of protamine sulfate during hemodialysis.
Understanding the mechanism of protamine-associated adverse reactions can improve patient safety.
Further research into platelet-mediated responses to protamine sulfate is warranted to refine clinical protocols.

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