Appropriate route for Vitamin K?

[RxBlueDevils]

PO is the best route for vitamin K adminstration, but what if the patient is NPO? I looked on Lexi-Comp and it said that IV administration is recommended only for life-threatening or serious bleeding secondary to warfarin. It also says that IM adminstration is not recommended. SQ is preferred if the patient cannot do PO.

However, on rotations my preceptor said that SQ administration is not appropriate because vitamin K is a fat soluble vitamin. So what is the appropriate route??

Also, there was a patient who was bleeding from the neck but the patient was not on warfarin therapy and the doctor wanted to give vitamin K by the IV route. Would vitamin K work in bleed that is not secondary to warfarin therapy?

It seems that the physician, pharmacist, and Lexi-Comp all have different opinions! What would you do for this patient and what is the appropriate route for vitamin K if the patient is NPO?

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[Aznfarmerboi]

PO is the best route for vitamin K adminstration, but what if the patient is NPO? I looked on Lexi-Comp and it said that IV administration is recommended only for life-threatening or serious bleeding secondary to warfarin. It also says that IM adminstration is not recommended. SQ is preferred if the patient cannot do PO.

However, on rotations my preceptor said that SQ administration is not appropriate because vitamin K is a fat soluble vitamin. So what is the appropriate route??

Also, there was a patient who was bleeding from the neck but the patient was not on warfarin therapy and the doctor wanted to give vitamin K by the IV route. Would vitamin K work in bleed that is not secondary to warfarin therapy?

It seems that the physician, pharmacist, and Lexi-Comp all have different opinions! What would you do for this patient and what is the appropriate route for vitamin K if the patient is NPO?

No... I do not think vitamin K is appropriate if the bleed is not secondary to warfarin therapy. This especially holds true if the physician is trying to use the vitamin k to stop the bleeding.

 

[J ROD]

NPO....I would give IV

 

[WVUPharm2007]

PO is the best route for vitamin K adminstration, but what if the patient is NPO? I looked on Lexi-Comp and it said that IV administration is recommended only for life-threatening or serious bleeding secondary to warfarin. It also says that IM adminstration is not recommended. SQ is preferred if the patient cannot do PO.

However, on rotations my preceptor said that SQ administration is not appropriate because vitamin K is a fat soluble vitamin. So what is the appropriate route??

Also, there was a patient who was bleeding from the neck but the patient was not on warfarin therapy and the doctor wanted to give vitamin K by the IV route. Would vitamin K work in bleed that is not secondary to warfarin therapy?

It seems that the physician, pharmacist, and Lexi-Comp all have different opinions! What would you do for this patient and what is the appropriate route for vitamin K if the patient is NPO?

The vast majority of the time, an SC administration is fine. The side of the ampule always says DO NOT GIVE IV in ominous lettering. It's due to a claimed risk of anaphylaxis...which I've never seen happen after seeing countless people get IV vitamin K after the local ED docs proclaim its an emergency and needs to be done NOW. 🙄 Just be sure that administration is slow and it should be ok. But if they are only giving it IV because they can't give it PO, I don't see why SC isn't ok.

And they give it prior to surgery without consideration of warfarin therapy. That might be why they are giving it...the vascular surgeon says so...

 

[spacecowgirl]

PO>>>>>>>>>>>>>>IV>>>>>>>>>>>>>>IM=SQ.

The % of people reaching normal INR with SQ was no different from placebo, so I don't like SQ. Unfortunately, I don't think there's anything comparing IM to SQ so I know some people prefer SQ over IM. If the person can't swallow a tablet, you can give parenteral vitamin K PO and it's a small volume.

 

[Praziquantel86]

I thought the issue against SQ vitamin K had to with a risk of crystallization and subsequent necrosis at the injection site...seems as if I'm mistaken.

Does anyone know what drug that might be then? Could be helpful to know.

 

[rxlea]

Funny. I just made a 10mg Vitamin K in 50ml NS.

 

[killerpenguin21]

PO>>>>>>>>>>>>>>IV>>>>>>>>>>>>>>IM=SQ.

The % of people reaching normal INR with SQ was no different from placebo, so I don't like SQ. Unfortunately, I don't think there's anything comparing IM to SQ so I know some people prefer SQ over IM. If the person can't swallow a tablet, you can give parenteral vitamin K PO and it's a small volume.

the problem with that arises when you watch the doctor order 50 po for a bleed that is due to warfarin 😱 only so he can tell you that IV is too dangerous.

i dont agree on the im=sq though, only because since its fat soluable, SQ can have really horrible kinetics and release in weird pulses lending itself to a difficult to handle balancing act of INR in the following hours.

 

[kvl1027]

I would always recommend IV before SQ admin of VitK. The the PK with SQ VitK is so variable and unreliable. PO is always the best option, if it is an option.

 

[SpirivaSunrise]

I thought the issue against SQ vitamin K had to with a risk of crystallization and subsequent necrosis at the injection site...seems as if I'm mistaken.

Does anyone know what drug that might be then? Could be helpful to know.

Promethazine

 

[MindOverMatter]

Source: CHEST Guidelines

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