IV and PO Vitamin K

Q: Oral Vitamin K has similar efficacy as intravenous (IV).

A) True

B) False

Answer: A

Some Pearls of Vitamin K (phytonadione)

• Oral Vitamin K has similar efficacy as intravenous Vitamin K. 
• SQ (subcutaneous) Vitamin K's absorption is unreliable.
• IM (intramuscular) Vitamin K may promote intramuscular hemorrhage.
• IV (intravenous) Vitamin K is effective in 6 - 8 hours.
• IV Vitamin K should be given very slowly (preferably .5 mg/min).
• IV Vitamin K may cause facial flushing, diaphoresis, chest pain, hypotension, dyspnea, anaphylaxis, and cerebral thrombosis but pretreatment with antihistamines or corticosteroids is not routinely recommended. 
• Although IV Vitamin K has been described as safe in a few studies, it should be used only in life-threatening bleeds from warfarin overdose or due to deficiency of vitamin K as fatality from anaphylactoid reaction could be high.

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References: 

1. Comparison of Oral vs Intravenous Phytonadione (Vitamin K) in Patients With Excessive Anticoagulation - Arch Intern Med. 2003;163:2469-2473.

 

2. Oral Vitamin K Lowers the International Normalized Ratio More Rapidly Than Subcutaneous Vitamin K in the Treatment of Warfarin-Associated Coagulopathy - Annals - 20 August 2002, Volume 137 Issue 4, Pages 251-254 

3. The safety of intravenously administered vitamin K - via pubmed, Vet Hum Toxicol. 2002 Jun;44(3):174-6.

4. Comparing Different Routes and Doses of Phytonadione for Reversing Excessive Anticoagulation - Arch Intern Med. 1998;158:2136-2140.

5. The incidence of anaphylaxis following intravenous phytonadione (vitamin K1): a 5-year retrospective review - Annals of Allergy, Asthma and Immunology, Volume 89, Number 4, October 2002, pp. 400-406(7)