vitamin-k-semiquinone-radical and Vomiting

We present here a late preterm infant with extensive brain lesions resulting from vitamin K deficiency. A female infant was born after 35 weeks of gestation by emergent cesarean section because of non-reassuring fetal status. Her mother had severe eating disorder and recurrent vomiting since early pregnancy. She was immediately intubated and ventilated because she was extremely pale, hypotonic, and non-reactive. Cerebral magnetic resonance imaging immediately after birth showed intraparenchymal hemorrhage in the left frontal lobe and cerebellum, marked cerebral edema, and cerebellar hypoplasia. Coagulation studies of the infant showed hepaplastin test <5%, prolonged PT and APTT, and a marked elevation of protein induced by vitamin K absence or antagonist-II. This case highlighted a potential risk of intracranial bleeding due to maternal vitamin K deficiency and difficulty in its prediction before delivery. Vitamin K supplementation to high risk mothers might be indispensable for preventing severe fetal vitamin K deficiency. Even when coagulation studies in mothers is normal, it is imperative to provide vitamin K supplementation for total protection.

Topics: Adult; Feeding and Eating Disorders; Female; Humans; Infant, Newborn; Intracranial Hemorrhages; Maternal Nutritional Physiological Phenomena; Mothers; Pregnancy; Pregnancy Complications, Hematologic; Prenatal Exposure Delayed Effects; Treatment Outcome; Vitamin K; Vitamin K Deficiency; Vomiting

Topics: Cerebral Hemorrhage; Emigrants and Immigrants; Germany; Humans; Infant Welfare; Infant, Newborn; Male; Psychomotor Agitation; Vitamin K; Vitamin K Deficiency; Vomiting

To report a case of prolonged vomiting during warfarin therapy, leading to an elevated international normalized ratio (INR).. A 32-year-old female with a history of cyclic vomiting syndrome since early childhood and bilateral pulmonary emboli diagnosed 4 months prior to this acute event presented to the clinic for routine monitoring of warfarin therapy. The warfarin dose had been maintained at 35 mg/wk for 3½ months (INR 2-3.5), but it was increased to 37.5 mg/wk because the INR had trended down to the low goal range over the preceding month. At presentation, the patient reported a 15-day history of vomiting with minimal oral intake that required intravenous fluids to prevent dehydration. The INR was 4.7; warfarin was withheld, and oral vitamin K 5 mg as well as subcutaneous vitamin K 10 mg was administered the following day. The INR then decreased to 1.3. Therapy was transitioned to subcutaneous enoxaparin 1 mg/kg every 12 hours for the duration of the patient's anticoagulation therapy.. Multiple reports have demonstrated malabsorption of warfarin and decreased INR response in the presence of underlying gastrointestinal disease. Despite a prolonged episode of cyclic vomiting syndrome, our patient had an elevated INR. In normal circumstances, warfarin is rapidly absorbed from the gastrointestinal tract and reaches maximum serum concentrations in approximately 90 minutes. Studies have shown that although the presence of food does not affect overall absorption of the medication, it can decrease the rate of absorption. Our patient was vomiting 20-30 minutes after oral dose administration. Because the patient was not consuming food, absorption of warfarin was potentially prompt, thus contributing to the elevated INR. The variability of vitamin K in the diet also can have significant impact on the response to warfarin. Our patient's INR had been stable while she consumed 3 servings each week of foods rich in vitamin K. This consumption was abruptly discontinued with the onset of the cyclic vomiting syndrome. We believe that decreased intake and retention of oral vitamin K-containing foods from the diet due to the prolonged vomiting coupled with the rapid onset of absorption resulted in a notably increased INR and subsequent bruising in our patient.. In the presence of prolonged vomiting, warfarin therapy requires more frequent monitoring than usual to detect fluctuations in INR that may increase the risk of adverse events.

Topics: Adult; Female; Humans; International Normalized Ratio; Risk Factors; Time Factors; Vitamin K; Vomiting; Warfarin

Topics: Antifibrinolytic Agents; Cerebral Infarction; Emergency Nursing; Emergency Treatment; Feeding and Eating Disorders; Female; Hematoma, Subdural; Home Childbirth; Humans; Infant; Infant, Newborn; Irritable Mood; Lethargy; Nursing Assessment; Partial Thromboplastin Time; Prothrombin Time; Tomography, X-Ray Computed; Vitamin K; Vitamin K Deficiency Bleeding; Vomiting

A 25-year-old man presented with macroscopic haematuria associated with a body mass index of 20 kg/m and a severe coagulopathy consistent with vitamin K deficiency. The diagnosis of a profound malabsorption syndrome secondary to coeliac disease was confirmed by small bowel histology and positive coeliac serology.

Topics: Abdominal Pain; Adult; Celiac Disease; Cheilitis; Diagnosis, Differential; Duodenum; Hematuria; Humans; Irritable Bowel Syndrome; Male; Treatment Outcome; Vitamin K; Vitamin K Deficiency; Vomiting

Topics: Follow-Up Studies; Hematuria; Hemorrhage; Humans; Infant, Newborn; Male; Treatment Outcome; Urinary Bladder Diseases; Vitamin K; Vitamin K Deficiency; Vomiting

Topics: Fructose Intolerance; Fructose Metabolism, Inborn Errors; Fructose-Bisphosphate Aldolase; Humans; Infant; Infant Food; Male; Vitamin K; Vomiting

Topics: Adrenal Cortex Hormones; Apnea; Biopsy, Needle; Blood Transfusion; Brain Diseases; Electroencephalography; Fatty Liver; Fever; Hepatic Encephalopathy; Humans; Infant; Liver; Male; Neomycin; Peritoneal Dialysis; Reye Syndrome; Unconsciousness; Vitamin K; Vomiting

Topics: Ascorbic Acid; Birth Weight; Breast Feeding; Gastroenteritis; Humans; Hypernatremia; Infant Food; Infant Nutrition Disorders; Infant Nutritional Physiological Phenomena; Infant, Newborn; Infant, Newborn, Diseases; Metabolism, Inborn Errors; Respiratory Tract Infections; Tetany; Vitamin A; Vitamin D; Vitamin K; Vomiting

Topics: Alcoholism; Anemia; Anemia, Macrocytic; Anorexia Nervosa; Ascorbic Acid; Avitaminosis; Celiac Disease; Deficiency Diseases; Diet; Diet Therapy; Female; Folic Acid; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Pregnancy; Pregnancy Complications; Sprue, Tropical; United Kingdom; Vitamin A; Vitamin B 12; Vitamin B Complex; Vitamin D; Vitamin K; Vitamins; Vomiting

Topics: Ascorbic Acid; Female; Humans; Nausea; Pregnancy; Pregnancy Complications; Vitamin K; Vitamin K 3; Vitamins; Vomiting

Topics: Ascorbic Acid; Female; Humans; Nausea; Pregnancy; Pregnancy Complications; Vitamin K; Vitamin K 3; Vitamins; Vomiting