Abstract Introduction Vitamin K (phytonadione) is commonly administered to correct coagulopathy in patients with chronic liver disease, particularly before procedures such as paracentesis. While the drug is generally safe, rare cases of anaphylaxis have been reported following intravenous administration. This reaction is attributed not to the vitamin itself but to its solubilizing agent, polyoxyethylated castor oil, which can trigger a non-IgE-mediated anaphylactoid response. Cirrhotic patients, with impaired hepatic clearance and altered immune responses, may be especially vulnerable. Recognizing and managing this complication promptly is essential to prevent fatal outcomes. Description A 78-year-old woman with autoimmune hepatitis complicated by decompensated cirrhosis (MELD-Na 24) and recurrent ascites presented with progressive abdominal distension and discomfort. Laboratory testing revealed an INR of 2.7 and total bilirubin of 5.1 mg/dL. To lower her INR before diagnostic paracentesis, intravenous vitamin K was administered. Within several minutes of infusion, she developed diffuse erythema, dyspnea, profound hypotension, and altered mental status. A rapid response was activated. She received immediate treatment with intravenous epinephrine, corticosteroids, and antihistamines, resulting in marked improvement in hemodynamics and mentation. The patient was transferred to the intensive care unit for monitoring and required short-term vasopressor support. CT imaging of the chest ruled out pulmonary embolism but revealed pulmonary edema and moderate ascites consistent with cirrhosis. Lactate levels trended down with resuscitation, and renal function improved. She stabilized within 24 hours and was transferred back to the medical floor without recurrence of symptoms. Discussion Anaphylaxis secondary to intravenous vitamin K is extremely uncommon but carries significant mortality if not promptly recognized. Reactions typically occur within minutes of administration and can present with respiratory compromise or cardiovascular collapse. In cirrhosis, elevated INR values often reflect impaired hepatic synthesis of clotting factors rather than true vitamin K deficiency, rendering supplementation less effective. Given this limited benefit and potential for harm, vitamin K should be used cautiously in this population. Alternatives such as prothrombin complex concentrate (PCC) or fresh frozen plasma (FFP) provide more predictable correction for procedural hemostasis. Conclusion This case highlights a rare yet severe hypersensitivity reaction to intravenous vitamin K in a patient with autoimmune cirrhosis. Rapid recognition and prompt administration of epinephrine were lifesaving. Clinicians should maintain a high index of suspicion for anaphylaxis when using parenteral vitamin K and consider safer, evidence-based alternatives for managing coagulopathy in advanced liver disease. This abstract is funded by: None
Sawh et al. (Fri,) studied this question.