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The development of hypoprothrombinaemia following antibiotic therapy in malnourished patients with low serum vitamin K 1 levels
Author(s) -
Cohen H.,
Scott S. D.,
Mackie I. J.,
Shearer M.,
Bax R.,
Karran S. J.,
Machin S. J.
Publication year - 1988
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.1988.tb04180.x
Subject(s) - cefotetan , medicine , antibiotics , gastroenterology , vitamin , sepsis , clotting factor , cephalosporin , malnutrition , surgery , chemistry , antibiotic resistance , biochemistry , imipenem
Summary. A group of nine well‐nourished patients, with normal serum vitamin K 1 levels (mean 546, range 310–1350 pg/ml), maintained normal prothrombin times (PTs) and factor VII clotting activities throughout a 7 d course of i.v. cefotetan disodium, an N‐methyl‐thiotetrazole (NMTT) containing cephalosporin antibiotic. However, 11 of 20 patients, with acute intra‐abdominal sepsis and initially normal PTs who underwent emergency surgery, developed prolonged PTs (INR 1.4–3.1) associated with reduction in factor VII activities (0.74–0.38 u/ml) after 3–7 d of antibiotic therapy. Nine of these 11 patients had clinical evidence of malnutrition and nine had subnormal serum vitamin K 1 levels (mean 119, range 43–354 pg/ml) on admission. Seven received cefotetan but four were treated with a non‐NMTT‐containing cephalosporin or antibiotics belonging to other groups. The nine patients who maintained normal PTs all had normal nutritional status and normal serum vitamin K 1 levels (mean 279, range 103–915 pg/ml) at presentation. The PT is a relatively insensitive indicator of vitamin K stores, and malnourished patients with low serum vitamin K 1 levels are at risk of developing hypoprothrombinaemia following intravenous antibiotic therapy.