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Quick Reference: Protamine Reaction

Consider the possibility of protamine reaction in patients allergic to fish, previous protamine exposure, diabetics on NPH insulin and men who have had vasectomies.
High risk patients can be treated with antihistamines and steroids prior to protamine administration.  Consider having the surgeon administer protamine into the left atrium or directly into the aorta.
Treatment:
  1. Stop protamine administration
  2. Use 100% FiO2
  3. Stop inhalational anesthetics
  4. Start  volume expanders
Drugs to Consider:
  • Calcium chloride, catecholamines, antihistamines, aminophylline and corticosteroids
Be prepared to give heparin and go back on CPB if no response to pharmacologic interventions.

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