Vitamin K

Accidental Administration of an Ergot Alkaloid to a Neonate

“We describe a neonate with altered splanchnic arterial blood flow after accidental substitution of an ergot alkaloid, methylergonovine maleate (MEM), for vitamin K1.”

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Accidental Poisoning of Newborn Infants with Ergonovine Maleate

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Anaphylactic shock due to vitamin K in a newborn and review of literature.

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🛑 Childhood cancer, intramuscular vitamin K, and pethidine given during labour.

“…but there was a significant association (p = 0.002) with intramuscular vitamin K (odds ratio 1.97, 95% confidence interval 1.3 to 3.0) when compared with oral vitamin K or no vitamin K. There was no significantly increased risk for children who had been given oral vitamin K when compared with no vitamin K (odds ratio 1.15, 95% confidence interval 0.5 to 2.7). These results could not be accounted for by other factors associated with administration of intramuscular vitamin K, such as type of delivery or admission to a special care baby unit.”

“The only two studies so far to have examined the relation between childhood cancer and intramuscular vitamin K have shown similar results, and the relation is biologically plausible. The prophylactic benefits against haemorrhagic disease are unlikely to exceed the potential adverse effects from intramuscular vitamin K. Since oral vitamin K has major benefits but no obvious adverse effects this could be the prophylaxis of choice.” 

#Cancer #Vitamin #K #MedScienceResearch

IV administration

A clinically suspected case of Anaphylactoid reaction to vitamin K injection in a child - a case report and review of literature.

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Inadvertent Methylergonovine Administration to a Neonate.

“Mistaking methylergonovine for vitamin K with accidental administration to the neonate is a rare iatrogenic illness occurring almost exclusively in the delivery room setting.”

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Late vitamin K deficiency bleeding after intramuscular prophylaxis at birth: a case report.

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Vitamin K, IM in an adult

Letter: Localized cutaneous reaction to intramuscular vitamin K in a patient with acute fatty liver of pregnancy.

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Neonatal ergot poisoning: a persistent iatrogenic illness.

“Ergot toxicity in the newborn usually manifests itself as respiratory depression, cyanosis, oliguria, and seizures. Death is usually caused by respiratory failure. A limited number of neonatal cases have been reported worldwide, and almost all cases involved confusion of maternal methylergonovine with neonatal vitamin K.”

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Nicolau syndrome induced by intramuscular vitamin K in a premature newborn.

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🛑 Observations on vitamin K deficiency in the fetus and newborn: has nature made a mistake?

“This protective effect of low K1 levels is particularly important in the presence of the high mitotic rates and rapid cell turnover in the avian embryo and mammalian fetus.”

“…K1 supplementation increases BP induced tumor formation in mice.”

#Vitamin #K #Cancer #MedScienceResearch

🛑 Oral versus intramuscular phytomenadione: safety and efficacy compared.

“Oral and intramuscular phytomenadione (vitamin K1) prophylaxis became an issue following the report of a potential carcinogenic effect of intramuscular but not oral phytomenadione prophylaxis. There is increasing evidence, however, that oral phytomenadione prophylaxis is less effective for the prevention of late vitamin K deficiency bleeding (VKDB) than intramuscular prophylaxis. Following a report of an increased cancer risk after intramuscular phytomenadione, a series of papers on this issue appeared. Although an increased risk for solid tumours could almost certainly be excluded, a potential risk for acute lymphatic leukaemia in childhood could not be ruled out definitively. Almost all cases of late VKDB are preventable with intramuscular phytomenadione prophylaxis administered once at birth, whereas a single oral dose given at birth is much less effective. Repeated oral phytomenadione doses given to breast-fed infants either weekly (1 mg) or daily (25 microg) seem to be as effective as intramuscular phytomenadione prophylaxis. The efficacy of 3 oral 2mg doses with the new mixed micellar preparation (‘Konakion MM’) remains to be established. Although a number of studies have failed to confirm a cancer risk with phytomenadione, these studies have been unable to rule out a risk definitely because absence of evidence is not evidence of absence. A meta-analysis of the available studies might provide 95% confidence intervals narrow enough to exclude even a small cancer risk with some certainty. Oral prophylaxis will probably be as safe as the intramuscular prophylaxis if given daily (25 microg) or weekly (1 mg).”

#Vitamin #K #Cancer #Leukemia #MedScienceResearch

Origins of and solutions for neonatal medication-dispensing errors.

“In 2008, there were five cases in which look-alike or sound-alike neonatal medication-dispensing errors occurred at our institution. A mix-up between neonatal and adult or pediatric products occurred in four of the five cases. Three of the five errors resulted in near misses with the potential to cause harm. The other two errors reached the patients but did not cause harm. The medication mix-ups involved adult and neonatal phytonadione injectable emulsion, sodium citrate injection and vancomycin-heparin combination injection, adult tetanus-diphtheria-acellular pertussis and infant diphtheria-tetanus-acellular pertussis (DTaP) vaccines, Haemophilus B and DTaP vaccines, and cisatracurium and vecuronium.”

#Error #Tdap #Hib #DTaP
#Vitamin #K #Vaccine

[Risk management by reporting critical incidents. Vitamin K and ephedrine mix-up at a birthing unit].

“Two incidents were reported, where ephedrine and adrenaline were found in a box supposed to contain vitamin K for new-born babies.”

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[Scleroderma-like patch on the thigh in infants after vitamin K injection at birth: six observations].

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An unusual mimicker of a sepsis outbreak: ergot intoxication.

“Methylergonovine (MEV) is a semi-synthetic ergot alkaloid used in the prevention and control of postpartum hemorrhage. This report describes 12 newborns born on the same day in a local country hospital in Turkey and developed sepsis-like symptoms and encephalopathy within the first 6 h of life due to accidental administration of MEV instead of vitamin K in the delivery room. The major features of MEV poisoning were lethargy (41.7%), seizure (75.0%), feeding intolerance (66.6%), hypoventilation (58.3%), irritability (25%), and peripheral circulatory abnormalities (58.3%). As a conclusion, clinical findings of ergot toxicity in newborns cannot be distinguished from infectious disease or neonatal encephalopathy.”

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[Vitamin K deficiency bleeding in an infant despite adequate prophylaxis].

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Why we need a clinical trial for vitamin K.

“Vitamin K is given to many babies born in the United Kingdom, but we still do not know if it has substantial hazards. Because the population exposed to vitamin K is very large even quite small hazards would involve many adverse events. It is therefore important to be able to put reasonably close bounds on the potential damage that vitamin K prophylaxis could cause. Past research has not allowed us to do this but a large randomised controlled clinical trial of vitamin K against no vitamin K, enrolling only infants at low risk of haemorrhagic disease, would do so. There is no question that vitamin K is a useful treatment in babies at highest risk of haemorrhagic disease: the question is whether the trend towards use of vitamin K in lower risk babies should be encouraged.”

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