Phytonadione Therapy in a Multiple-Drug Overdose Involving Warfarin

Duane Bates, B.Sc.(Pharm.), and Marcy Mintz, M.D.

Disclosures

Pharmacotherapy. 2000;20(10) 

In This Article

Adverse Effects of Vitamin K

Severe adverse effects are associated with intravenous phytonadione, such as cardiac irregularities, chest pain, cyanosis, decreased level of consciousness, circulatory collapse, rapid weak pulse, hypotension, and cardiac or respiratory arrest.[13] It is not known if these reactions are due to the drug or the injection vehicle.[13] Earlier reactions to vitamin K were thought to be due to polyoxyethylated castor oil (cremophor).[29,30,31,32]

The literature contains numerous cases of anaphylactic reactions[29,30,32,33,34,35,36,37,38] as well as fatalities[34,35] with parenteral phytonadione. The recommended infusion rate of vitamin K is no faster than 1 mg/minute[13]; however, anaphylactic reactions have occurred with slower infusion rates[33,37] as well as with repeated exposure to intravenous vitamin K.[30,33,34,37]

Dermatologic reactions were reported after intravenous, subcutaneous, and intramuscular administration of vitamin K.[39] Two distinct types of local cutaneous reactions have been described. The more common one is a pruritic, erythematous, eczematoid, indurated plaque measuring 6-20 cm around the site of injection.[39,40,41,42,43,44,45,46,47,48,49,50,51,52] The acute reaction may resolve in 2-4 weeks with treatment with high-potency corticosteroids (e.g., fluocinonide, betamethasone dipropionate). The second type appears as a scleroderma or morphea-like reaction.[53,54,55,56] The onset can be weeks to months, and the skin change may last for years.[39] Dose does not appear to bear a relationship to the onset of these reactions. Liver disease was associated with most reports of vitamin K cutaneous hypersensitivity,[39,41] but the pathophysiology is unclear.

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