Successful re-treatment in a patient with protamine allergy by a slow intravenous injection method
10.3760/cma.j.issn.1008-5734.2020.02.015
- VernacularTitle:鱼精蛋白过敏患者缓慢静脉滴注法再次治疗成功
- Author:
Yarui MO
1
;
Yiyi QIAN
1
Author Information
1. 云南省阜外心血管病医院药剂科，昆明 650032
- Publication Type:Journal Article
- Keywords:
Protamines;
Anaphylaxis
- From:
Adverse Drug Reactions Journal
2020;22(2):117-119
- CountryChina
- Language:Chinese
-
Abstract:
A 74-year-old male patient underwent aortic valve replacement and coronary artery bypass grafting under general anesthesia and cardiopulmonary bypass for valvular heart disease. After cardiopulmonary bypass, protamine sulfate injection 50 mg (5 ml) was slowly intravenously injected to neutralize heparin sodium. At about 3 minutes of the injection (injection dose was about 15 mg), the patient suddenly developed decreased blood pressure, increased heart rate, and shortness of breath. Redness appeared on the skin around the injection site and there were light red rashes. In consideration of protamine allergy, the infusion was stopped immediately and anti-allergic drugs such as diphenhydramine, dexamethasone, and adrenaline were injected intravenously. After about 30 minutes, his blood pressure increased, heart rate decreased, and the rashes gradually subsided. Due to insufficient dose of protamine, the patient had more oozing and exudation in the thoracic cavity, resulting in a decrease in blood pressure and prolonged prothrombin time. Then protamine sulfate injection 50 mg (5 ml) diluted in 0.9% sodium chloride injection 100 ml was given by intravenous injection at a rate of 60 drops/min. The patient did not have any allergy again, the pleural drainage fluid was gradually reduced, and his blood pressure returned to normal.
