Death due to vitamin K

[Guest]

I just posted a new addition to my web page on vitamin K. It involves the death of a patient who was treated because of an abnormal lab value, not because there was anything actually harmful wrong with her.

You can read it at http://www.warfarinfo.com/vitamin-K.htm

I know a lot of you looked at this page recently and may not want to read it all again - it is the second paragraph under the frist heading "To Reverse an Elevated INR"

 

[Nancy]

This hits very close to home Al, and I'm glad you posted it. Joe has been administered Vitamin K under doctors orders on two occasions.

Once when they implanted his pacemaker and his INR wasn't where it needed to be. His doctor was going to go on vacation and didn't want to wait around for it to get to where it needed to be. It took almost three weeks in the hospital afterwards to get his Coumadin back in the therapeutic range.

The second time was a very dangerous situation in many respects. Joe had a major bleedout after gallbladder surgery. He almost bled to death. It took 33 units of blood products to try to stop his bleed. He was administered Vitamin K, plasma and his Coumadin was held for over a week. Just when they were going to restart his Coumadin again, one of the nurses thought it would be a good idea to take him for a walk so he wouldn't get pneumonia. The act of getting him out of bed, broke open his surgical site again and he started to bleed all over again. They had to wait on the Coumadin once more. I thought I would lose my mind for sure! Fortunately, Joe survived all the stupidity. But that was a very close call.

Thank God I'm Irish. Everybody got nailed that day. Big BAD scatter shot.

By the way, how long does Vitamin K stay in the system, affecting the INR?

 

[Guest]

An IV injection of 10 mg of vitamin K can make you resistant to warfarin for up to two weeks.

Not only are you at risk from the low INR but if the warfarin dose is increased during this time, then when the effect wears off, the INR can be higher than it was before the problem started.

Doses of vitamin K given by mouth are around for a shorter period of time.

 

[KristyW]

What about intramuscular or subcutaneous?

What about intramuscular or subcutaneous?

Al,

This is very timely for me. I went into the hospital on Thursday afternoon before my normal warfarin dose for severe "flank" pain. The Dr's decided it was a kidney stone. They checked my INR and it was at 8.7. Of course this freaked them out completely. Late Thursday evening the nurse gave me an Intramuscular or Subcutaneous (not sure which) shot of Vit K. I do not know what the dose was though. Friday a.m. my INR was 7.0. I was released, told to hold the Warfarin for Friday, and then check in with my Dr. today (Saturday) for a stat protime. Today I'm at 2.3. My Dr. said to go back on my 40mg/week dose as I was very consistent with my INR until this incident. Since my surgery my INR has been 2.3 - 3.1 for over 2 years.

I guess my questions to are, do kidney stones have any effect on INR (I'm reaching, I know.), and how much do I need to worry about my theraputic levels for the next few days/weeks?

 

[Guest]

I think that any illness is likely to cause an elevated INR. I think that the reason is that when you are sick, you don't eat like usual and you are less active.

Less eating usually means less intake of vitamin K.

Less active means that you don't get your heart rate up like you do when you are active. Therefore, the blood does not go through the liver as many times. Therefore, the warfarin is metabolized less.

My greatest concern is people who call and say that they are not feeling well and that they cannot come for their INR check. These are the times when you need to have it done.

I think that putting you back on the dose of warfarin that worked well was wise, but I'd get another check this week, just to be sure that it is close to the desired range.

 

[KristyW]

Thanks Al,

I was already planning to go back for another check on Thursday.