food poisoning and INR

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tommyboy14

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Mar 17, 2014
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231
Location
London, United Kingdom
Hi Team,

I either had mild food poisoning this weekend or a viral infection that gave me all the same symptoms.

I usually check INR on Sunday. Last Sunday was 2.4. Today was 5.3. What a jump.

Did anyone else have such a large jump from infection or food poisoning?

I will skip my warfarin today and tomorrow. I also ordered Vit K and will take 1 mg when it gets here tomorrow.

I hope that all of these steps will help me get in line again.

All the best and thanks for any input
Tommy
 
Hi Team,

I either had mild food poisoning this weekend or a viral infection that gave me all the same symptoms.

I usually check INR on Sunday. Last Sunday was 2.4. Today was 5.3. What a jump.

Did anyone else have such a large jump from infection or food poisoning?

I will skip my warfarin today and tomorrow. I also ordered Vit K and will take 1 mg when it gets here tomorrow.

I hope that all of these steps will help me get in line again.

All the best and thanks for any input
Tommy
That seems to be an unusual jump in INR. I'd try another test now to see if it was truly around 5+ or just a bad test. I've had it happen for apparently no reason.......although diarrhea caused by the food poisoning might cause such a jump.
 
I usually check INR on Sunday. Last Sunday was 2.4. Today was 5.3. What a jump.
p450 has been busy with the other toxins ... good thing you checked. If you're doing lots of vomiting or the other end then it would be good to lower that.

sorry to read of that, and I hope that you keep an eye on it as you come out of it and p450 can attend to "lower priority toxins" it may just send you low (you know, like going hyper-glycemic can send you hypo in the cascade afterwards)
 
Yes, I have had that happen with food poisoning and the flu. If you are not eating well and also “vacating” it can really mess with warfarin levels. If it was me, I would not skip more than one day. One day usually brings it way down for me. Check your level after the skip and adjust accordingly dependent on how the other symptoms are.
 
I thought it would be helpful to update everyone what I did and what happend:

Sunday: Measure 5.3 INR skip warfarin dose
Monday: Measure 4.2 INR skip warfarin dose and take 1mg vit k
Tuesday: Measure 1.5 INR at Anticoag clinic and also my own meter
Tuesday: Take 170% of regular warfarin dose
Wednesday: Take 130% of regualar warfarin dose
Thursday: Back to normal
Friday: 2.1 INR


Lesson for me: @pellicle told me to only reduce by 50% the second day rather than skipping the whole dose. Clearly I should have listened to him. That is what I will do next time. And I think Vit K was probably overkill.

Shout out to the UK NHS though. Although people complain all the time, I went to my local Anti-coag clinic on Tuesday. It was actually closed - I didnt know. But after explaining what happened, they took me in any way and tested in 5 minutes and compared my meter against theirs. They also called me on Friday to make sure I tested again and asking if everything was ok.

I would really like to thank @pellicle for this advice. I am still a newbie to self-management and will continue to learn from him.
 
Monday: Measure 4.2 INR skip warfarin dose and take 1mg vit k
Tuesday: Measure 1.5 INR at Anticoag clinic and also my own meter
There is a difference of 2.7 between your own and laboratory measurements over two days. Even if you didn't take Warfarin on Monday, don't you think this difference is abnormal?
Could your inr meter have measured incorrectly?
 
There is a difference of 2.7 between your own and laboratory measurements over two days. Even if you didn't take Warfarin on Monday, don't you think this difference is abnormal?
Could your inr meter have measured incorrectly?
sorry if i didnt express this correctly.

On tuesday anticoag clinic meter was 1.4 and mine was 1.5. The large drop in INR was because i shouldnt have skipped a second day.
 
I thought it would be helpful to update everyone what I did and what happend:

Sunday: Measure 5.3 INR skip warfarin dose
Monday: Measure 4.2 INR skip warfarin dose and take 1mg vit k
Tuesday: Measure 1.5 INR at Anticoag clinic and also my own meter
Tuesday: Take 170% of regular warfarin dose
Wednesday: Take 130% of regualar warfarin dose
Thursday: Back to normal
Friday: 2.1 INR


Lesson for me: @pellicle told me to only reduce by 50% the second day rather than skipping the whole dose. Clearly I should have listened to him. That is what I will do next time. And I think Vit K was probably overkill.

Shout out to the UK NHS though. Although people complain all the time, I went to my local Anti-coag clinic on Tuesday. It was actually closed - I didnt know. But after explaining what happened, they took me in any way and tested in 5 minutes and compared my meter against theirs. They also called me on Friday to make sure I tested again and asking if everything was ok.

I would really like to thank @pellicle for this advice. I am still a newbie to self-management and will continue to learn from him.
Thanks for sharing your experience so that others may learn from it.

And I think Vit K was probably overkill.
I totally agree with you.

Your INR was already in a relatively safe place and moving downward at a quick rate. No need to supplement with oral vitamin K. When my INR hit 9.7, 4 days after release from the hospital, due to interference from amiodarone, I was told to hold my warfarin, of course, and the coumadin clinic also prescribed 2.5mg of vitamin k. Turns out that in my area a vitamin k prescription is hard to fill. When it was unclear if I would be able to get it filled or how soon, the coumadin clinic guided me to take some vitamin k2, which I had on hand. Several hours later, after calling every pharmacy in town, I was finally able to fill the vit k prescription. But, the coumadin clinic had not made it clear to me if I was to take the vitamin k, in addition to the vit k2 they had already had me take. And they were closed now. And I was somewhat conflicted, as someone had informed me that vitamin k2 does not lower INR. So, I took 2.5mg of vitamin k, in addition to the k2 I had taken already, and in addition to holding my warfarin.

The result was that the combination of holding my warfarin and taking the vitamin k and k2, my INR went from 9.7 to about 1.7. A little bit of a roller coaster followed, over the next couple of days. From my experience, I would definitely not feel the need to take any vitamin k if my INR was 4.2 and moving downward quickly. INR of 4.2 is relatively safe, especially if brief and things are heading in the right direction, but prescriptin vitamin k can cause INR to drop lower than intended. Best for use when INR is much higher, in my view. Hindsight is 20/20 and I have read a lot more literature on the subject, but if I had it to do over again, I would only take 1mg of vitamin k and not 2.5mg, but I was just following the guidance of the coumadin clinic at the time.


You may find the publication below an interesting read. They put the range of INR warranting 1mg of vitamin k at 4.5 to 10. Personally, I would tend to have a higher low threshold than that and not mess around with vitamin k unless my INR was above 6. Holding a dose tends to really make a big impact for me.

"Vitamin K given orally is more effective than subcutaneous vitamin K injection, and as effective as intravenous administration when INR values are compared 24 hours after administration. A 1.0-mg vitamin K dose is likely most appropriate for patients with INR values between 4.5 and 10."


https://www.ncbi.nlm.nih.gov/pmc/ar...n K given orally is,values between 4.5 and 10.
 
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