Shock due to protamine hypersensitivity.

C A Cobb; D L Fung

doi:10.1016/0090-3019(82)90112-4

Home/Archive/PubMed

PubMed · 7079946

Shock due to protamine hypersensitivity.

C A Cobb·D L Fung

View original source ↗Export metadata ↓

Abstract

A 56-year-old man developed shock and skin flush minutes after the slow administration of 25 mg of protamine sulfate. Prior protamine exposure from treatment of his diabetes with isophane insulin (NPH insulin) was believed to have sensitized this patient to protamine. A review of three other cases of reaction to low doses of protamine revealed that in each, the patient had previously been exposed to protamine. If heparin is used in a patient with a history of treatment of diabetes with isophane insulin, the heparin should be allowed to spontaneously reverse, without pharmacological assistance if possible. If protamine must be used, the patient should be pretreated with glucocorticoid and vasopressors should be immediately available.

Explore related subjects

Diabetes Mellitus Drug Hypersensitivity Humans Insulin, Isophane Male Middle Aged Protamines Shock Case Reports Journal Article

Keep this discovery

Explore connections, maps & timelines

BibTeX RIS

C A Cobb, D L Fung. 1982. Shock due to protamine hypersensitivity.. https://doi.org/10.1016/0090-3019(82)90112-4

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2007

JAMA patient page. Insulin.

Explore the source record for details and available documents.

Diabetes Mellitus↗

PubMed2007

Allergy reactions to insulin: effects of continuous subcutaneous insulin infusion and insulin analogues.

The purification of animal insulin preparations and the use of human recombinant insulin have markedly reduced the incidence but not completely suppressed the occurrence of insulin allergy manifestations. Advances in technologies concerning the mode of delivery of insulin, i.e. continuous subcutaneous insulin infusion (CSII), and the use of insulin analogues, resulting from the alteration in the amino acid sequence of the native insulin molecule, may influence the immunogenicity and antigenicity of native insulin. Instead of increasing allergy reactions, CSII has been reported to represent a successful alternative treatment in diabetic patients presenting local or generalized allergy to insulin or other components (zinc, protamine) of conventional treatment. Most recent reports concern CSII-treated patients using short-acting insulin analogues (essentially insulin lispro), although the precise role of these insulin analogues remains unclear as allergy to them has also been described. Finally, data on antigenicity and immunogenicity of long-acting insulin analogues (glargine, detemir), which may mimic the basal insulin delivery with CSII, remain scarce at present.

Diabetes Mellitus↗

PubMed2007

Effects of glucose homeostasis on protein metabolism in patients with advanced chronic kidney disease.

Insulin deficiency is known to be associated with a state of increased muscle protein breakdown; this process is mediated by the ubiquitin-proteasome pathway. Convincing in vitro data are further supported by extensive studies in humans with insulin deprivation and are further substantiated by reversal of muscle protein breakdown with insulin treatment. In patients with end-stage renal disease (ESRD) and diabetes mellitus (DM), muscle protein breakdown is enhanced in both acute and chronic conditions. Recent data also point to the potential protein catabolic effects of insulin resistance combined with insulin deficiency. Because ESRD is associated with a state of insulin resistance, uremic muscle wasting may also be mediated by this pathway.

Diabetes Mellitus↗