vitamin-k-1 and Liver-Diseases

Between 1964 and 1994, at least 52 patients with cutaneous adverse effects of vitamin K have been described in the European and North American literature. A review of the details of these patients is given and 2 new cases reported. Adverse effects are seen not only in patients with liver-function disturbances but also in patients without liver diseases, and occur mostly after intramuscular or subcutaneous administration of vitamin K1, independent of the total dose. Patch and intracutaneous tests often give positive reactions. The mechanism of action is probably in many patients a delayed-type hypersensitivity reaction.

Topics: Adolescent; Adult; Aged; Child; Dermatitis, Allergic Contact; Dermatitis, Contact; Erythema; Europe; Female; Humans; Injections; Intradermal Tests; Liver Diseases; Male; Middle Aged; Patch Tests; United States; Vitamin K; Vitamin K 1

In patients with severe acute liver dysfunction, i.v. phylloquinone (vitamin K1) may be given to exclude vitamin K deficiency, rather than impaired hepatic synthesis of coagulation factors alone, as the cause of the coagulopathy. However, there have been no studies of the pharmacokinetics or efficacy of i.v. or oral K1 in such patients.. 49 adults with severe acute liver disease were randomised double-blind to a single 10 mg dose of i.v. or oral mixed-micellar K(1), or placebo. Serum levels of phylloquinone and undercarboxylated prothrombin (PIVKA-II) were assessed before and after treatment.. At admission, 13 patients (27%) had either low serum K1 levels or elevated PIVKA-II concentrations, indicative of subclinical vitamin K deficiency. In the 16 patients who received i.v. K1, there was one (6%) treatment failure (K1 rise <10 ng/ml above baseline), compared with 12 of the 15 (80%) who received oral K1 (P<0.0001). One patient in the placebo group developed overt vitamin K deficiency.. A minority of patients with severe acute liver dysfunction have subclinical vitamin K deficiency at the time of presentation, which is corrected by a single dose of i.v. K1. The intestinal absorption of mixed-micellar K1 is unreliable in adults with severe acute liver dysfunction.

Topics: Acute Disease; Administration, Oral; Adolescent; Adult; Aged; Double-Blind Method; Female; Half-Life; Humans; Injections, Intravenous; Intestinal Absorption; Liver Diseases; Male; Middle Aged; Placebos; Vitamin K 1

Topics: Blood Coagulation; Hemostatics; Humans; Liver; Liver Diseases; Liver Neoplasms; Postoperative Period; Vitamin K; Vitamin K 1; Vitamin K 2

Serum level of vitamin K1 (= phylloquinone, hereinafter K1) and K dependent blood coagulation factors were determined by HPLC in normal subject, liver cirrhosis, hepatocellular carcinoma, acute hepatitis, chronic hepatitis, chronic renal failure with hemodialysis and patients under warfarin therapy. Normal range of serum K1 concentration was decided on 0.20-2.30 (0.87 +/- 0.53, n = 96) ng/ml. Serum K1 level showed no significant differences among normal subject, various diseases and warfarin therapy. Correlation between serum K1 level and F-VII (r = 0.879, p less than 0.001) or protein C activity (r = 0.839, p less than 0.01) was found in patients whose thrombotest was 20% and less. However serum K1 level didn't correlate with any K dependent coagulation factors in patients if thrombotest was over 20%.

Topics: Adolescent; Adult; Blood Coagulation Factors; Female; Heart Diseases; Humans; Kidney Failure, Chronic; Liver Diseases; Male; Protein C; Vitamin K 1; Warfarin

Cutaneous hypersensitivity to vitamin K1 injection has been reported once in North America. This case and most of the others in European literature have been associated with alcoholic liver disease. We report six patients who developed persistent skin hypersensitivity reactions at the site of vitamin K1 injection. These cases are the first reported to occur in liver disease associated with primary biliary cirrhosis, chronic myeloid leukemia, amyloidosis, and preeclampsia. Patch and intradermal skin tests demonstrated a hypersensitivity that seems to have an immune basis and is restricted to fat-soluble vitamin K1. This finding suggests that patients with any type of liver disease may be at risk for vitamin K hypersensitivity and that the hypersensitivity may be a marker of liver disease.

Topics: Adult; Drug Eruptions; Female; Humans; Hypersensitivity, Delayed; Injections, Intramuscular; Injections, Subcutaneous; Liver Diseases; Male; Middle Aged; Risk; Skin Tests; Vitamin K 1

Factor VII levels have been measured in 100 patients with liver disease following parenteral vitamin K1 therapy. There was good agreement between specific factor VII measurements and the one-stage prothrombin time apart from six patients with compensated cirrhosis in whom the prothrombin time was prolonged despite the presence of normal factor VII levels. A mean activity of 58% was found in patients with cirrhosis. Cirrhotic patients with features of hepatic decompensation had a significantly lower mean level of activity (40%) than the "contrast" patients with surgical obstruction of the major bile ducts (93%). Patients with chronic active liver disease had moderate depression of factor VII levels and those with non-cirrhotic liver damage had mean activities similar to the contrast group. Factor VII levels could not be correlated with BSP retention but there was a correlation with serum albumin concentration. It is concluded that the prothrombin time using Quick test with a standardized thromboplastin showing good sensitivity to factor VII, eg, the Manchester reagent (BCT), provides a reliable index of coagulability in chronic liver disease, and specific factor VII assays are not indicated.

Topics: Cholestasis; Chronic Disease; Factor VII; Humans; Liver Cirrhosis; Liver Diseases; Liver Function Tests; Prothrombin Time; Vitamin K 1

Two patients with erythematous, tender, indurated plaques at the site of intramuscular injections of vitamin K1 are described. In one of these, condition was reproduced by the injection of a test dose. In both cases, there was associated liver disease. The red, indurated plaques cleared in 4-14 days. There have been two previous reports in the literature of similar lesions. Altough some of the patients showed sclerodermatous changes at the same site within 2 years of the injections. These unusual reactions have only been seen in patients with liver disease and when a variety of drugs have been administered. It may be that these factors are important in the initiation of the cutaneous response.

Topics: Adult; Erythema; Female; Humans; Injections, Intramuscular; Liver Diseases; Vitamin K 1

Topics: Acute Disease; Adolescent; Adult; Aged; Biotransformation; Chronic Disease; Ethers; Fructose; Half-Life; Hepatitis A; Humans; Hypoglycemic Agents; Liver Diseases; Middle Aged; Pyrimidines; Renal Dialysis; Spectrophotometry; Sulfonamides; Tolbutamide; Transaminases; Vitamin K 1; Vitamins

Topics: Animals; Antigen-Antibody Reactions; Azathioprine; Bone Marrow Diseases; Erythrocytes; Humans; In Vitro Techniques; Kidney Diseases; Leukocytes; Liver; Liver Diseases; Lymphocytes; Metabolic Diseases; Mice; Sheep; Transferases; Vitamin K 1

Topics: Adrenal Cortex Hormones; Anabolic Agents; Animals; Diet; Liver; Liver Diseases; Microscopy, Electron; Rats; Vitamin E; Vitamin K 1

Topics: Bile; Bile Duct Neoplasms; Biliary Tract; Biliary Tract Diseases; Cholangiography; Cholelithiasis; Cholestasis; Contrast Media; Diagnosis, Differential; Female; Gallstones; Hemorrhage; Hepatitis; Humans; Liver Diseases; Male; Methods; Neoplasm Metastasis; Pancreatic Neoplasms; Peritonitis; Prothrombin Time; Vitamin K 1

Topics: Biliary Tract; Female; Hemorrhage; Hemorrhagic Disorders; Humans; Liver Diseases; Postpartum Hemorrhage; Postpartum Period; Vitamin K 1

Topics: Antifibrinolytic Agents; Liver Diseases; Naphthoquinones; Retinoids; Vitamin K; Vitamin K 1

Topics: Antifibrinolytic Agents; Humans; Liver Diseases; Naphthoquinones; Retinoids; Vitamin K; Vitamin K 1

Topics: Antifibrinolytic Agents; Heparin Antagonists; Humans; Hypoprothrombinemias; Liver Diseases; Prothrombin; Vitamin K; Vitamin K 1

Topics: Antifibrinolytic Agents; Child; Humans; Infant; Liver Diseases; Naphthoquinones; Retinoids; Vitamin K; Vitamin K 1

Topics: Blood Coagulation; Blood Coagulation Factors; Factor V; Factor VII; Humans; Liver Diseases; Prothrombin; Vitamin K; Vitamin K 1

Topics: Blood Coagulation; Blood Coagulation Factors; Blood Coagulation Tests; Factor V; Factor VII; Humans; Liver Diseases; Liver Function Tests; Prothrombin; Prothrombin Time; Vitamin K; Vitamin K 1