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General practice and family medicine
Successful oral phytonadione (vitamin K) challenge following an infusion-related reaction to intravenous phytonadione
  1. T Michael Farley1,2,
  2. Daniel J Leary3 and
  3. Faith R Poelker4
  1. 1Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, Iowa, USA
  2. 2Pharmacy Practice, South Dakota State University College of Pharmacy and Allied Health Professions, Brookings, South Dakota, USA
  3. 3Hospitalist Program, University of Iowa Health Care, Iowa City, Iowa, USA
  4. 4University of Iowa College of Pharmacy, Iowa City, Iowa, USA
  1. Correspondence to Dr T Michael Farley; mike.farley{at}sdstate.edu

Abstract

A woman in her early 60s presented to the emergency room with worsening pain 10 days after an injury to her right abdomen. CT revealed a large subcutaneous haematoma and contained small bowel perforation. She was tachycardic and anaemic and her international normalized ratio (INR) was 2.6 on warfarin for atrial fibrillation. General surgery was consulted and percutaneous drainage of the perforation was recommended, requiring an INR of 1.5 or less. Intravenous (IV) phytonadione was administered to accelerate the lowering of INR; however, the patient developed a severe infusion-related reaction. She recovered once IV phytonadione was stopped and oral diphenhydramine was administered. However, there was still a need for warfarin reversal therapy. A 1.25 mg dose of oral phytonadione was trialled 2.5 hours later and well tolerated. An additional rechallenge of 5 mg by mouth was given without reaction (<8 hours after the initial reaction). Her INR was 1.5 the next morning.

  • Vitamins and supplements
  • Safety
  • Unwanted effects / adverse reactions

https://doi.org/10.1136/bcr-2024-261987

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    Footnotes

    • Contributors The following authors were directly involved in the patient’s care: TMF, DJL and FRP. The guarantor, TMF, supervised the preparation of the manuscript, obtained informed consent from the patient, guardian or family members and is responsible for the overall integrity of the manuscript’s content. TMF, DJL and FRP were responsible for drafting the text, sourcing and editing clinical images, reviewing investigation results, creating original diagrams and algorithms and performing critical revisions for significant intellectual content. All authors (TMF, DJL and FRP) gave final approval of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.