Noncardiogenic Pulmonary Edema and Rhabdomyolysis after Protamine Administration in a Patient with Unrecognized McArdle's Disease

Abstract

THE spectrum of adverse reactions associated with protamine administration after cardiopulmonary bypass (CPB) is varied. Noncardiogenic pulmonary edema (NCPE), hyperthermia, and rhabdomyolysis all have been reported separately.1'2 We report the case of a patient who developed intraoperative NCPE followed by hyperthermia and massive rhabdomyolysis after repair of tetralogy of Fallot. Postoperatively he was found to have absence of skeletal mus cle myophosphorylase compatible with McArdle's disease.