Suggest Treatment For Raised INR

Posted on Mon, 8 Sep 2014

Question: (1) Is an INR of 2.1 AND a PT Test result of 22.4 seconds a sufficient basis for the administration of 1 mg of Vitamin K if the patient is not on warfarin or any other anticoagulant treatment and there is no evidence of bleeding? (2) Is anaphylaxis always obvious, especially in a person who has delirium, e.g., is there always an apparent facial swelling? (3) Is it possible for anaphylaxis to cause a sudden drop in blood pressure 24 hours after the initiating cause?

Answered by Dr. Jyothi B L (4 hours later)

Brief Answer:
Vit K 1 mg is not toxic.

Detailed Answer:
Hi,
I am Dr. Jyothi BL and I will be answering:

1. Raised INR on patient without warfarin therapy, commonest cause is secondary to liver failure. Certain clotting factors are produced in liver which might be deficient leading to increased INR. Vit K at this dosage would help in improving production of clotting factors. At this dosage, it is not high enough to cause toxicity or any complications.

2. Anaphylaxis is a condition of immediate response to allergic reaction. It is mostly generalized. Superficially, facial swelling, lips, tongue, throat along with wheezing and rashes can be seen. These are the usual manifestations.

3. Delayed anaphylaxis can occur after a certain time without any trigger. When it is anaphylaxis, sudden drop in blood pressure is very common.

Hope it helps.
Any further queries, happy to help again.

Dr. Jyothi BL

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Jyothi B L (8 hours later)

Thank you Dr XXXXXXX BL. May I ask two more questions? You mentioned that some of the symptoms of anaphylaxis can be superficial. Is it possible that the symptoms of anaphylaxis could go unobserved even by a doctor (at least initially), especially if the patient has agitated delirium? Also, if there are rashes, are they purple in colour?

Answered by Dr. Jyothi B L (10 hours later)

Brief Answer:
Delirious state can complicate symptoms of anaphylaxis

Detailed Answer:
Hi,

I would like to state my opinion as follows:

1. Associated delirious state can complicate manifestations of anaphylaxis and can make it complicated to diagnose.

2. If you can specify the type of rashes, as rashes are usually initially red due to increased blood moving to superficial areas, and later on they will become purple. Also Purple colored lesions might be healing hemorrhages. However, if you have severe cyanosis, it could be light bluish.

Any further queries, ready to help again.

Dr. Jyothi BL

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Above answer was peer-reviewed by : Dr. Ashwin Bhandari