Protamine sulfate reversal of heparin is generally dosed based on what factor?

• A. The color of heparin used
• B. The amount of heparin given
• C. The route of administration
• D. The patient's age

Answer: (B)

Protamine sulfate dosing hinges on how much heparin was given because the neutralization is stoichiometric. In practice, about 1 mg of protamine is needed for each 100 units of heparin administered. So, if 5,000 units of heparin were given, roughly 50 mg of protamine would be used. The dose is guided by the amount of heparin, not by the color of the heparin, the route it was given, or the patient’s age. If there’s ongoing heparin infusion or residual heparin from surgery, additional protamine may be needed, but dosing aims to match the total heparin exposure. Administer IV slowly and monitor for adverse reactions such as hypotension or allergic-type responses.