What is the immediate treatment for acute heparin toxicity?

The immediate treatment for acute heparin toxicity is protamine sulfate. Heparin is an anticoagulant that works by inhibiting thrombin and factor Xa in the coagulation cascade, and excessive anticoagulation can lead to bleeding complications. Protamine sulfate is a strongly basic protein that binds to heparin, thus neutralizing its anticoagulant effects.

When administered, protamine forms a stable complex with heparin, effectively reversing its effects almost immediately. This makes protamine sulfate the specific antidote for heparin overdose and the optimal choice in acute situations where rapid correction of heparin's effects is necessary to prevent serious hemorrhagic events.

In contrast, Vitamin K is used for reversing the effects of vitamin K antagonists (like warfarin), not heparin. Calcium gluconate is often used for conditions related to low calcium levels or magnesium overdose but has no role in reversing heparin's effects. Oral anticoagulants would not be appropriate for treating acute heparin toxicity, as they would not provide rapid reversal and could exacerbate the bleeding risk.