Vitamin K

 Q: Vitamin K can be administrated after diluting with orange juice?

A) Yes

B) No

Answer: A

Administration of Vitamin K (phytonadione) in ICU via intravenous (IV) infusion is common, but this should always be remembered that despite all precautions such as enough dilution and slow infusion fatal reaction may occur with IV infusion. Extra precaution should be taken if a patient is receiving vitamin K for the first time. Moreover, this can occur via the intramuscular (IM) route too where there is an extra risk of hematoma formation. The subcutaneous route is safe but carries the risk of erratic and unpredictable absorption. 

The objective of this question is to emphasize that the oral route is the best route for vitamin K unless an urgent reversal of coagulopathy is needed. It can also be administrated by diluting in beverages if a pill cannot be swallowed. 

Another mistake many clinicians do is by ordering an ala-carte dose of 10 mg even in non-urgent cases. A lower dose of 1 to 2.5 mg is usually sufficient. 10 mg should be given in extremely urgent cases of bleeding.

#pharmacology

#hematology

References:

1. Vanier MC and Ngo TT. Reversal of overanticoagulation with vitamin K1: A plea for oral administration. Can J Hosp Pharm. 2006;59:125-135. 

2. Ageno W, Gallus AS, Wittkowsky A, Crowther M, Hylek EM, Palareti G. Oral anticoagulant therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2)(suppl):e44s-e88s. doi:10.1378/chest.11-2292