Vitamin K 1 -Induced Anaphylactic Shock

Abstract

Objective:

To report a case of anaphylactic shock induced by the rapid intravenous administration of vitamin K₁ in a patient in the intensive care unit (ICU).

Case Summary:

A 9-year-old Malay girl was admitted to the ICU and was diagnosed with Guillain-Barré syndrome. She developed an allergy to atropine that was manifested by a symmetric generalized transient macular rash over the trunk; it subsided 10 minutes after the drug was stopped. About 7 hours later, vitamin K₁ 10 mg iv was administered over 3 minutes due to the slight prolongation of prothrombin time and activated partial thromboplastin time. Immediately after the drug was administered, the patient developed a generalized transient macular rash, cyanosis, and shock. Her blood pressure and heart rate could not be detected. She responded well, however, after resuscitation.

Discussion:

Anaphylactic shock in this patient was most probably caused by the intravenous administration of vitamin K₁, because this event occurred immediately after its administration. There have also been a few reported cases of severe reaction and death associated with intravenous administration of vitamin K₁. The likelihood that the incident was drug-related could be classified as “probable” based on Naranjo's causal relationship algorithm.

Conclusions:

Rapid intravenous administration of vitamin K₁ may induce anaphylactic shock in a critically ill patient with hemodynamic instability. If vitamin K₁ is required, oral administration is preferred because it is rarely associated with severe reactions. Intravenous administration of vitamin K₁ should be considered only in an emergency situation and the rate of administration should not exceed 1 mg/min.