Wednesday, July 31, 2019


Q: Risk of side effects with protamine increases in all of the following patients except? 

 A) allergy to fish 
B) previous vasectomy 
C) severe left ventricular dysfunction 
 D) end stage renal disease (ESRD) 
E) abnormal pulmonary hemodynamics 

Answer: D

Side effects of protamine sulfate include hypotension, noncardiogenic pulmonary edema, severe pulmonary vasoconstriction, and pulmonary hypertension. Unfortunately there are many risk factors which are not easy to identify. Risk factors include rapid administration, previous administration of protamine-containing drugs like NPH insulin, and some beta-blockers, allergy to fish, previous vasectomy, and severe left ventricular dysfunction.

Renal or hepatic failure does not augment protamine reactions.



Caravati EM. Protamine sulfate. Medical Toxicology. 3rd ed. Dart RC, ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2004;243-244.

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